Kauai Nicole Kennedy-Eto, M,D., MPH

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A127206 Issued in CA

Practice address

1711 N. Orange Street
Redlands, CA 92374-2254

Phone

(909) 792-2200

Fax

(909) 792-2660

NPI assigned

Jun 22, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kauai Nicole Kennedy Other name

Medicare fee-for-service enrollment

Enrolled in CA

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 PracticeAlso: Obstetrics/Gynecology

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mommy and Me Medical Group IncGroup PAC ID 0244383727, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kauai.kennedyeto.p2@direct.mpmccorp.nextgenshare.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Mommy and Me Medical Group, Inc.

  • Family Medicine Physician
  • Riverside, CA
  • NPI 1730258765
  Medicare reassignment Care Compare group NPD
• Senior'S Choice Medical Group, Inc.

  • Family Medicine Physician
  • Fontana, CA
  • NPI 1023506672
  NPD (past)

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

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438560000000",
    "number": "1568758100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 N. ORANGE STREET",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923742254",
            "telephone_number": "909-792-2200",
            "fax_number": "909-792-2660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 N. ORANGE STREET",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923742254",
            "telephone_number": "909-792-2200",
            "fax_number": "909-792-2660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY-ETO",
        "first_name": "KAUAI",
        "middle_name": "NICOLE",
        "credential": "M,D., MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-22",
        "last_updated": "2015-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A127206",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A127206",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAUAI",
            "last_name": "KENNEDY",
            "middle_name": "NICOLE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kelsey Kellar, PT, DPT
• Shannon Ruth Kelleher, MSW
• Kyle Keller, RD
• Maryceleste Kelley
• Takeysha Kelly, FNP-C
• Casey M. Kennedy, MD
• Britny Rose Kerwin
• Keys Family Resource Center
• Sanaz Khaleghi
• Amanda Khalil, MD

• Family Medicine Physician in Redlands, CA
• Providers in Redlands, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2015; 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.