NPIMap

Individual provider Active NPI

William Kennen Jr., DO

  • Orthopaedic Surgery Physician
  • Festus, MO
National Provider Identifier
1700878147
Registry record updated Sep 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
2010002299 Issued in MO
Practice address
1400 Highway 61
Moc South, Suite 210
Festus, MO 63028-4100
Phone
(636) 933-8050
Fax
(646) 933-8075
NPI assigned
Aug 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 2010002299 MO Primary
Orthopaedic Surgery Physician 207X00000X OS005811L PA

Addresses

Primary practice location

1400 Highway 61
Moc South, Suite 210
Festus, MO 63028-4100

Mailing address

1400 Highway 61
Moc South, Suite 210
Festus, MO 63028-4100
Phone (636) 933-8050

Other identifiers 1

IdentifierTypeStateIssuer
1700878147MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2010002299MOMDOrthopaedic Surgery Physician
OS005811LPAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson Physician Network, LLC Past Accepting new patients
Greengate Orthopaedic Group P.C. Orthopaedic Surgery Past Accepting new patients
Windber Hospital, Inc. Past Accepting new patients
E. William Kennen Orthopaedics,PC Orthopaedic Surgery PastSince Jan 1, 1990 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379894400000",
    "number": "1700878147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 HIGHWAY 61",
            "address_2": "MOC SOUTH, SUITE 210",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284100",
            "telephone_number": "636-933-8050",
            "fax_number": "636-933-8075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 HIGHWAY 61",
            "address_2": "MOC SOUTH, SUITE 210",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284100",
            "telephone_number": "636-933-8050",
            "fax_number": "646-933-8075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEN",
        "first_name": "WILLIAM",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-22",
        "last_updated": "2013-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MO",
            "license": "2010002299",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "PA",
            "license": "OS005811L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700878147",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Festus, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.