Mary L. Kennedy, D.O.
Individual provider Active NPI Family Medicine Physician · Webb City, MO
NPI 1659312841 · NPPES record last updated Mar 17, 2016
Key facts
- NPI
- 1659312841
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 2001016563 (MO)
- Practice address
- 6151 N Main Street Rd
Webb City, MO 64870-8189 - Phone
- (417) 781-0408
- Fax
- (417) 556-5377
- NPI assigned
- Jun 9, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 12
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- At Still University of Health Sciences, College of Osteo Med, Kirksville, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mercy Clinic Joplin LLC
Practice addresses (Care Compare)
100 Mercy Way
Joplin, MO 64804-4524
1717 S Range Line Rd B
Joplin, MO 64804-3224
6151 N Main St Rd
Webb City, MO 64870-8189
Phone (417) 781-0408
Hospital & facility affiliations
- Integrity Home Care + Hospice
- Amedisys Home Health of Missouri
- Mercy Hospital Joplin
- Mercy Hospital Carthage
- Freeman Health System - Freeman West
- Mercy Specialty Hospital Southeast Kansas
- Mercy Hospital Columbus
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- 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 |
|---|---|---|---|---|
| I20050301000344 | MO | Practitioner - Family Practice | 8426001579 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2001016563 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Hospital Carthage | Current | Accepting new patients | |
| Mercy Clinic Joplin LLC | Family Medicine | Current |
Accepting new patients |
| Mercy Southern Missouri Ambulatory Services LLC | Current |
Accepting new patients | |
| Alliance Radiology, PA | Past |
Accepting new patients | |
| Lincoln County Hospital | Past | Accepting new patients | |
| Sjmgroup | Past | Accepting new patients |
Locations
3125 Dr Russell Smith Way
Carthage, MO 64836
Phone (417) 358-8121
94 Main St
Cassville, MO 65625
Phone (417) 782-7722
100 Mercy Way
Joplin, MO 64804
Phone (417) 556-2300
3126 S Jackson Ave
Joplin, MO 64804
Phone (417) 782-1600
1421 S Range Line Rd
Ste C
Joplin, MO 64801
Phone (417) 434-9445
2150 W Republic Rd
Ste 112
Springfield, MO 65807
Phone (417) 986-1291
6151 N Main Street Rd
Webb City, MO 64870
Phone (417) 556-5350
Interoperability endpoints
- mkennedy190709@directb.mercy.net
- mkennedy200166@directc.mercy.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2001016563 | MO | Yes |
Addresses
Primary practice location
6151 N Main Street Rd
Webb City, MO 64870-8189
Mailing address
6151 N Main Street Rd
Webb City, MO 64870-8189
Phone (417) 781-0408
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00800446 | Other | MO | RAIL ROAD MEDICARE |
| 1659312841 | Medicaid | MO |
Other providers in Webb City, MO
- Amberlyn Jarman
- Lesia Jarnagin
- Kassidy Lynn Johnston
- Natasha Kataria
- Kerri Kelley
- Russell L. Kennedy
- Linda Margaret Kent
- Erin Elizabeth Kern
- Glen W. King
- Janessa Kingore
All providers in Webb City, MO · Family Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2016. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.