Shelby A. Kenner, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01061016A Issued in IN

Practice address

5717 S Anthony Blvd
Suite 100
Fort Wayne, IN 46806-3386

Phone

(260) 469-3984

Fax

(260) 441-3375

NPI assigned

Aug 11, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Shelby A. Dietrich Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Indiana University School of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lutheran Medical Group LLCGroup PAC ID 4981751617, 251 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adoration Home Health Home health agency, Fort Wayne, IN, CCN 157583
• Dupont Hospital LLC Hospital, Fort Wayne, IN, CCN 150150
• Lutheran Hospital of Indiana Hospital, Fort Wayne, IN, CCN 150017
• Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021
• St Joseph Health System, LLC Hospital, Fort Wayne, IN, CCN 150047
• Bluffton Regional Medical Center Hospital, Bluffton, IN, CCN 150075

Merit-based Incentive Payment System (MIPS)

Final score

90.99 of 100Reported as apm

Quality

77.41

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lutheran Medical Group LLC

  • Cardiovascular Disease Physician
  • Fort Wayne, IN
  • NPI 1164662805
  Medicare reassignment Care Compare group NPD
• Lutheran Medical Group LLC

  • Durable Medical Equipment & Medical Supplies
  • Fort Wayne, IN
  • NPI 1710275664
  NPD
• Brooklyn Medical Associates, PC

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1851512198
  NPD (past)
• Fort Wayne Medical Education Program

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1184635153
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Amedisys SP-in, L.L.C.

  • Home Health Agency
  • Marion, IN
  • NPI 1497959142
  Care Compare affiliation
• Amedisys SP-in, LLC

  • Home Health Agency
  • Fort Wayne, IN
  • NPI 1437103199
  Care Compare affiliation
• Bluffton Health System LLC

  • General Acute Care Hospital
  • Bluffton, IN
  • NPI 1376594366
  Care Compare affiliation
• Dupont Hospital LLC

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1538110556
  Care Compare affiliation
• Iom Health System LP

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1306897335
  Care Compare affiliation
• Parkview Hospital, Inc.

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1366407603
  Care Compare affiliation
• St. Joseph Health System, LLC

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1023060472
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1538170832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6920 POINTE INVERNESS WAY STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468047934",
            "telephone_number": "260-458-3210",
            "fax_number": "260-458-3211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5717 S ANTHONY BLVD",
            "address_2": "SUITE 100",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468063386",
            "telephone_number": "260-469-3984",
            "fax_number": "260-441-3375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNER",
        "first_name": "SHELBY",
        "middle_name": "A.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01061016A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000519082",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200531880",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00405718",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shelby.kenner@lutheranhealthnetwork.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "5717 S Anthony Blvd",
            "address_2": "Suite 100",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468063386",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHELBY",
            "last_name": "DIETRICH",
            "middle_name": "A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alison Louise Kennedy
• Amber Kennedy, BSN, RN
• Christina Tan Michelle Kennedy, O.D.
• Jin Jin Kennedy, RBT
• Judith L Kennedy, MD
• Jasmine Kennerly, RN
• Kenneth a. Bundza and Sherwin Y. Kepes
• Sherwin Y. Kepes, PH.D.
• Michelle Keplar, MSW, LSW
• Patricia Keplinger, COTA

• Family Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.