Individual provider Active NPI

Kyle W Kennedy, DO

  • Emergency Medicine Physician
  • Joplin, MO
National Provider Identifier
1609883909
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2004009698 Issued in MO
Practice address
1102 West 32ND Street
Joplin, MO 64804
Phone
(417) 347-1111
Fax
(417) 347-2149
NPI assigned
Aug 1, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2004009698 MO Primary

Addresses

Primary practice location

1102 West 32ND Street
Joplin, MO 64804

Mailing address

1102 West 32ND Street
Joplin, MO 64804
Phone (417) 347-1111

Other identifiers 2

IdentifierTypeStateIssuer
204642102MedicaidMO
243419306MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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

Enrollment IDStateProvider typePAC IDDetails
I20041101000771 MO Practitioner - Emergency Medicine 1759343858 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Oklahoma State University College of Osteopathic Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Freeman-Oak Hill Health SystemGroup PAC ID 8325942253, 385 clinicians

Practice addresses (Care Compare)

1102 W 32 St
Joplin, MO 64804-3503
Phone (417) 347-1111

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.37 of 100Reported as group
Quality
60.15
Promoting interoperability
100
Improvement activities
40
Cost
77.74

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3768OKMDProfessional Counselor
2004009698MOMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Freeman Neosho Hospital CurrentSince Apr 27, 2021 Accepting new patients
Freeman-Oak Hill Health System Past Accepting new patients
Lightstar Emergency Physicians, PLLC Emergency Medicine Past Accepting new patients

Locations

1102 W 32nd St
Joplin, MO 64804
Phone (417) 347-1078

113 W Hickory St
Neosho, MO 64850
Phone (417) 347-1078

Organizations & group practices 5

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

Hospital & facility affiliations 2

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": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609883909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 WEST 32ND STREET",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "64804",
            "telephone_number": "417-347-1111",
            "fax_number": "417-347-2149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 WEST 32ND STREET",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "64804",
            "telephone_number": "417-347-1111",
            "fax_number": "417-347-2149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "KYLE",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2004009698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204642102",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "243419306",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Joplin, MO

Sources for this page

Verify at the official NPI Registry.