NPIMap

Individual provider Active NPI

Stephen D Kennedy, MD

  • Family Medicine Physician
  • Peru, IN
National Provider Identifier
1700957123
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01044433 Issued in IN
Practice address
751 W 2ND St Ste 100
Peru, IN 46970-1385
Phone
(765) 919-4378
Fax
(765) 919-4672
NPI assigned
Nov 10, 2006
Last updated
Aug 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 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 01044433 IN Primary

Addresses

Primary practice location

751 W 2ND St Ste 100
Peru, IN 46970-1385

Mailing address

751 W 2ND St Ste 100
Peru, IN 46970-1385
Phone (765) 919-4378

Other identifiers 2

IdentifierTypeStateIssuer
200091180 BMedicaidIN
P01418893OtherINRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040820000469 IN Practitioner - Family PracticePractitioner - Internal Medicine 7214901859 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial HospitalGroup PAC ID 8123923281, 64 clinicians
Parkview Logansport Hospital IncGroup PAC ID 8921500646, 41 clinicians

Practice addresses (Care Compare)

1101 Michigan Ave
Loganport, IN 46947-1528
Phone (574) 753-1548

751 W 2ND St
Suite 100
Peru, IN 46970-1385
Phone (574) 753-7541

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01044433INMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Parkview Logansport Hospital, Inc. CurrentSince Nov 1, 2014 Accepting new patients
Parkview Logansport Hospital, Inc. CurrentSince Nov 1, 2014 Accepting new patients
Advanced Care Center, LLC Past Accepting new patients
Memorial Hospital Past Accepting new patients
Unity Urgent Care LLC Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

1101 Michigan Ave
Logansport, IN 46947
Phone (574) 753-1475

1694 W Logansport Rd
Peru, IN 46970
Phone (765) 472-2519

751 W 2nd St
Ste 100
Peru, IN 46970
Phone (765) 919-4378

Interoperability endpoints

  • FHIR API: https://arrprd.mhhcc.org/OAuth2/api/FHIR/R4/
  • FHIR API: https://fhir-myrecord.cerner.com/r4/62ec6f7d-af4b-46d8-93b5-703ae9be8c7e/

Organizations & group practices 6

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1700957123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 W 2ND ST STE 100",
            "city": "PERU",
            "state": "IN",
            "postal_code": "469701385",
            "telephone_number": "765-919-4378",
            "fax_number": "765-919-4672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 W 2ND ST STE 100",
            "city": "PERU",
            "state": "IN",
            "postal_code": "469701385",
            "telephone_number": "765-919-4378",
            "fax_number": "765-919-4672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "STEPHEN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-10",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01044433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200091180 B",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01418893",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peru, IN

Sources for this page

Verify at the official NPI Registry.