Patrick James Kennedye – Family Medicine Physician

Key facts

NPI: 1649650649
Entity type: Individual (NPI type 1)
Primary specialty: Family Medicine Physician 207Q00000X
License: 31372 (OK)
Practice address: 2601 Spencer Rd
Spencer, OK 73084
Phone: (405) 427-2441
Fax: (405) 427-4741
NPI assigned: Jun 4, 2015
Sex: Male
Sole proprietor: No

Organizations & group practices 4

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.

Citizen Potawatomi Nation Federally Qualified Health Center (FQHC) · Shawnee, OK · NPI 1881981744

Medicare reassignment NPD TX
Integris Ambulatory Care Corporation Family Medicine Physician · Oklahoma City, OK · NPI 1750333936

Medicare reassignment NPD FAMILY MEDICINE · OK
Citizen Potawatomi Nation Federally Qualified Health Center (FQHC) · Shawnee, OK · NPI 1194752949

NPD
Citizen Potawatomi Nation Chiropractor · Shawnee, OK · NPI 1427659523

NPD

Medicare participation

Medicare fee-for-service enrollment: Enrolled (2 enrollments) in OK, TX
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20170207002726	OK	Practitioner - Family Practice	7214222835	Reassigns benefits to 1 organization
I20180905001720	TX	Practitioner - Family Practice	7214222835	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

Practice roles

Organization	Specialty	Status	New patients
Citizen Potawatomi Nation		Current since Aug 6, 2018	Accepting new patients
Citizen Potawatomi Nation		Current	Accepting new patients
Citizen Potawatomi Nation		Current since Aug 6, 2018	Accepting new patients
Integris Ambulatory Care Corporation	Family Medicine	Current since Feb 25, 2017	Accepting new patients

Locations

5300 N Independence Ave
Ste 280
Oklahoma City, OK 73112
Phone (405) 552-0155

3500 NW 56th St
Ste 100
Oklahoma City, OK 73112
Phone (405) 951-2855

3400 NW Expressway
Ste 500
Oklahoma City, OK 73112
Phone (405) 945-4589

781 Grand Casino Blvd
Shawnee, OK 74804
Phone (405) 964-4025

2307 Gordon Cooper Dr
Shawnee, OK 74801
Phone (405) 273-5236

2601 Spencer Rd
Spencer, OK 73084
Phone (405) 427-2441

Interoperability endpoints

FHIR API: https://epicproxy.et1447.epichosted.com/APIProxyPRD/api/FHIR/R4

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician	207Q00000X	31372	OK	Yes

Addresses

Primary practice location

2601 Spencer Rd
Spencer, OK 73084

Mailing address

5300 N Independence Ave Ste 280
Oklahoma City, OK 73112-5555
Phone (405) 427-2441

Other providers in Spencer, OK

All providers in Spencer, OK · Family Medicine Physician in Oklahoma

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2018. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.