Individual provider Active NPI

Kennedy Grovogel

  • Physician Assistant
  • Indianapolis, IN
National Provider Identifier
1689432312
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
8433 Harcourt Rd Ste 310
Indianapolis, IN 46260-2198
Phone
(317) 338-9393
NPI assigned
Mar 7, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

8433 Harcourt Rd Ste 310
Indianapolis, IN 46260-2198

Mailing address

8433 Harcourt Rd Ste 310
Indianapolis, IN 46260-2198
Phone (317) 338-9393

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20260319001134 IN Practitioner - Physician Assistant 3870077639 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

8433 Harcourt Rd
Suite 310
Indianapolis, IN 46260-2190

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatology Associates of Indiana PC CurrentSince Feb 10, 2026 Accepting new patients

Locations

8433 Harcourt Rd
Ste 310
Indianapolis, IN 46260
Phone (317) 338-9393

Organizations & group practices 1

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": "1709769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1689432312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8433 HARCOURT RD STE 310",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602198",
            "telephone_number": "317-338-9393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8433 HARCOURT RD STE 310",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602198",
            "telephone_number": "317-338-9393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROVOGEL",
        "first_name": "KENNEDY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-07",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.