Shane W Kennedy, MD

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

L6086 Issued in TX

Practice address

2221 8TH Ave
Fort Worth, TX 76110-1812

Phone

(817) 336-5060

Fax

(817) 336-1744

NPI assigned

Jun 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in TX

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

Nephrology

Education

University of Texas Southwestern Medical School at Dallas, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dialysis AssociatesGroup PAC ID 1557308319, 25 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fresenius Medical Care Ft Worth Parkway Dialysis facility, Fort Worth, TX, CCN 672568
• FMC Granbury Dialysis facility, Granbury, TX, CCN 452805
• Texas Health Harris Methodist Hospital Southwest F Hospital, Fort Worth, TX, CCN 450779
• Texas Health Harris Methodist Fort Worth Hospital, Fort Worth, TX, CCN 450135
• Baylor Scott and White All Saints Medical Center Hospital, Fort Worth, TX, CCN 450137
• Texas Health Huguley Hospital Fort Worth South Hospital, Fort Worth, TX, CCN 450677
• Texas Health Harris Methodist Hospital Alliance Hospital, Fort Worth, TX, CCN 670085

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: skennedy28985@direct.acumenmd.com

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.

• Dialysis Associates

  • Nephrology Physician
  • Fort Worth, TX
  • NPI 1346250446
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Fresenius Medical Care Granbury, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Granbury, TX
  • NPI 1093266330

  Dialysis facility

  Care Compare affiliation Name & address match
• Baylor All Saints Medical Center

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1669472387
  Care Compare affiliation
• Texas Health Harris Methodist Hospital Alliance

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1215296884
  Care Compare affiliation
• Texas Health Harris Methodist Hospital Fort Worth

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1336172105
  Care Compare affiliation
• Texas Health Harris Methodist Hospital Southwest Fort Worth

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1417980202
  Care Compare affiliation
• Texas Health Huguley, Inc

  • Psychiatric Hospital Unit
  • Burleson, TX
  • NPI 1518355759
  Care Compare affiliation
• Texas Health Huguley, Inc.

  • General Acute Care Hospital
  • Burleson, TX
  • NPI 1033120423
  Care Compare affiliation
• Texas Health Huguley, Inc.

  • Psychiatric Hospital Unit
  • Burleson, TX
  • NPI 1548273881
  Care Compare affiliation

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1679517569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 8TH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761101812",
            "telephone_number": "817-336-5060",
            "fax_number": "817-336-1744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2221 8TH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761101812",
            "telephone_number": "817-336-5060",
            "fax_number": "817-336-1744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "SHANE",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "L6086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158632301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00040101",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10012357",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISYS",
            "identifier": "1634611",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TX",
            "identifier": "8J5430",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7724474",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Devan Kennedy, LCSW
• Jason Matthew Kennedy, M.D.
• Jeanette Nicole Kennedy, DNP, APRN-NP,FNP-C
• Leekelli Kennedy, RD LD
• Paul A Kennedy III, MD
• Siobhan Kennedy
• Kirsten Renee Kennemer, AU.D.
• Kenneth James Buley MD
• Kenneth Ray Ruelas Jr
• Kenneth Wayne Morris

• Nephrology Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Nephrology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; 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.