Individual provider Active NPI

Kennedy Garcia, PA

  • Family Medicine Physician
  • Tulsa, OK
National Provider Identifier
1649937731
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4692 Issued in OK
Practice address
10109 E 79TH St
Tulsa, OK 74133-4564
Phone
(918) 233-9550
NPI assigned
Nov 23, 2021
Last updated
Aug 28, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4692 OK Primary

Addresses

Primary practice location

10109 E 79TH St
Tulsa, OK 74133-4564

Mailing address

10109 E 79TH St
Tulsa, OK 74133-4564

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, OK2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220124001081 TX Practitioner - Physician Assistant 9133511249 Reassigns benefits to 2 organizations
I20240717001829 OK Practitioner - Physician Assistant 9133511249 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Creek Nation Hospital and ClinicsGroup PAC ID 5698786226, 364 clinicians

Practice addresses (Care Compare)

10109 E 79TH St
Tulsa, OK 74133-4564
Phone (918) 756-4333

1313 E 20TH St
Okmulgee Indian Health Center
Okmulgee, OK 74447-6303
Phone (918) 591-5700

500 Eunice Burns Rd
Eufaula, OK 74432-4052
Phone (918) 689-2547

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.12 of 100Reported as group
Quality
83.76
Promoting interoperability
100
Improvement activities
40
Cost
56.64

Merit-based Incentive Payment System (MIPS)

Final score
85.4 of 100Reported as group
Quality
72.78
Promoting interoperability
98
Improvement activities
40
Cost
76.77

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4692OKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cherokee Nation CurrentSince Feb 13, 2022 Accepting new patients
Cherokee Nation Current Accepting new patients
Creek Nation Hospital & Clinics Family Medicine CurrentSince Jul 15, 2024 Accepting new patients
Cherokee Nation Current Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Jul 15, 2024 Accepting new patients
Cherokee Nation Current Accepting new patients
Cherokee Nation CurrentSince Feb 13, 2022 Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Jul 15, 2024 Accepting new patients
Cherokee Nation Current Accepting new patients
Creek Nation Hospital & Clinics Past Accepting new patients

Locations

859 E Melton Dr
Jay, OK 74346
Phone (918) 253-4271

1001 S 41st St E
#3
Muskogee, OK 74403
Phone (918) 687-0201

1020 Lenape Dr
Nowata, OK 74048
Phone (918) 273-0192

1101 S Belmont Ave
Ste 204
Okmulgee, OK 74447
Phone (918) 756-3526

900 E Airport Rd
Okmulgee, OK 74447
Phone 91875643334448

900 N Owen Walters Blvd
Salina, OK 74365
Phone (918) 434-8500

471688 Highway 51
Stilwell, OK 74960

100 S Bliss Ave
Tahlequah, OK 74464
Phone (918) 458-3100

10109 E 79th St
Tulsa, OK 74133
Phone (888) 552-6760

Dept 1467
Tulsa, OK 74182

Dept 2269
Tulsa, OK 74182

27371 S 4410 Rd
Vinita, OK 74301
Phone (918) 256-4800

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1637625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1649937731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10109 E 79TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741334564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10109 E 79TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741334564",
            "telephone_number": "918-233-9550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARCIA",
        "first_name": "KENNEDY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-23",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "4692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.