Individual provider Active NPI

William Powell Kennedy, M.D.

  • Otolaryngology Physician
  • Reston, VA
National Provider Identifier
1558723320
Registry record updated May 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
0101271845 Issued in VA
Practice address
1860 Town Center Dr Ste 335
Reston, VA 20190-5900
Phone
(703) 787-3322
NPI assigned
Mar 22, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Otolaryngology Physician 207Y00000X 0101271845 VA Primary

Addresses

Primary practice location

1860 Town Center Dr Ste 335
Reston, VA 20190-5900

Mailing address

1860 Town Center Dr Ste 335
Reston, VA 20190-5900
Phone (703) 787-3322

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210709002085 DC Practitioner - Otolaryngology 3274824073 Reassigns benefits to 1 organization
I20210712002177 VA Practitioner - Otolaryngology 3274824073 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Perelman School of Med at the University of Pennsylvania, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Reston Ear Nose and Throat PCGroup PAC ID 0941305445, 7 clinicians

Practice addresses (Care Compare)

1860 Town Ctr Dr
Suite 335
Reston, VA 20190-5900
Phone (703) 787-3322

24430 Stone Springs Blvd
Suite 250a
Dulles, VA 20166-2267
Phone (703) 787-3322

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101271845VAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Reston Ear Nose and Throat PC Otolaryngology CurrentSince Sep 1, 2021 Accepting new patients
Edwin J Lee MD PC Otolaryngology PastSince Jun 22, 2021 Accepting new patients

Locations

3580 Joseph Siewick Dr
Ste 208
Fairfax, VA 22033
Phone (703) 787-3322

12600 Fair Lakes Cir
Ste 102
Fairfax, VA 22033

1860 Town Center Dr
Ste 335
Reston, VA 20190
Phone (703) 787-3322

Interoperability endpoints

  • Direct secure messaging: wkennedy@restonent.emadirect.md

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622073600000",
    "number": "1558723320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 TOWN CENTER DR STE 335",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905900",
            "telephone_number": "703-787-3322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 TOWN CENTER DR STE 335",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905900",
            "telephone_number": "703-787-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "WILLIAM",
        "middle_name": "POWELL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-22",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "VA",
            "license": "0101271845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reston, VA

Sources for this page

Verify at the official NPI Registry.