Individual provider Active NPI

Michael J. Kennelly, MD

  • Urology Physician
  • Charlotte, NC
National Provider Identifier
1720021637
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
9500634 Issued in NC
Practice address
1225 Harding PL
Ste 3100
Charlotte, NC 28204-2826
Phone
(704) 355-8686
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician 2088F0040X 9500634 NC
Urology Physician 208800000X 9500634 NC Primary

Addresses

Primary practice location

1225 Harding PL
Ste 3100
Charlotte, NC 28204-2826

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

1100 Blythe Blvd
Charlotte, NC 28203-5814
Phone (704) 355-9330

Other practice location 2

1350 S Kings Dr
Charlotte, NC 28207-2134
Phone (704) 446-1255

Other practice location 3

2001 Vail Ave
Ste 360
Charlotte, NC 28207-1248
Phone (704) 304-1160

Other practice location 4

1025 Morehead Medical Dr
Ste 300
Charlotte, NC 28204-2963
Phone (704) 355-4593

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network
Direct Messaging Address mkennelly137111@CarolinasHealthcareSystem.direct-ci.com Atrium Health

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20050826000912 NC Practitioner - Urology 4183655350 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Cincinnati College of Medicine, 1989
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Carolinas Medical CenterGroup PAC ID 4789597477, 1,057 clinicians
Comprehab, IncGroup PAC ID 2769653757, 376 clinicians

Practice addresses (Care Compare)

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-2000

1225 Harding PL
Charlotte, NC 28204-2826

1237 Harding PL
Suite 3300
Charlotte, NC 28204-2826
Phone (704) 355-8816

2001 Vail Ave
Charlotte, NC 28207-1222

2001 Vail Ave
Charlotte, NC 28207-1248
Phone (704) 304-5000

2675 Court Dr
Gastonia, NC 28054-1478
Phone (704) 824-7800

920 Church St N
Concord, NC 28025-2927
Phone (704) 403-3000

Hospital & facility affiliations

  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113
  • Carolinas Medical Center-Northeast Hospital, Concord, NC, CCN 340001
  • Atrium Health Pineville Hospital, Charlotte, NC, CCN 340098
  • Carolinas Rehabilitation Inpatient rehabilitation facility, Charlotte, NC, CCN 343026

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
00634NCMDDermatology Physician
9500634NCMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center CurrentSince Jan 1, 2007 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Dec 6, 2020 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Urology CurrentSince Dec 6, 2020 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients
Carolinas Medical Center Current Accepting new patients
Carolinas Medical Center Urology CurrentSince Jan 1, 2007 Accepting new patients
Stone Institute of the Carolinas LLC Urology CurrentSince Nov 23, 2015 Accepting new patients
Carolinas Pathology Group, PA Current Accepting new patients
Carolinas Health Network, Inc. Urology Past Accepting new patients
Carolinas Physicians Network, Inc Past Accepting new patients

Locations

100 N 6th St
Ste 900A
Minneapolis, MN 55403

2001 Vail Ave
Ste 360
Charlotte, NC 28207
Phone (704) 304-1160

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

1227 Harding PL
Ste 3100
Charlotte, NC 28204

1023 Edgehill Rd S
Charlotte, NC 28207
Phone (704) 355-8686

1225 Harding Pl
Ste 3100
Charlotte, NC 28204
Phone (704) 355-8686

1001 Blythe Blvd
Ste 200
Charlotte, NC 28203
Phone (704) 373-0544

1100 Blythe Blvd
Charlotte, NC 28203
Phone (704) 355-4300

1350 S Kings Dr
Charlotte, NC 28207
Phone (704) 446-1255

1025 Morehead Medical Dr
Ste 300
Charlotte, NC 28204
Phone (704) 355-1813

441 McAlister Rd
Ste 1200
Lincolnton, NC 28092
Phone (980) 212-6200

Interoperability endpoints

  • Direct secure messaging: mkennelly137111@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 11

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.

Hospital & facility affiliations 11

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1720021637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 HARDING PL",
            "address_2": "STE 3100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042826",
            "telephone_number": "704-355-8686"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Blythe Blvd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035814",
            "country_code": "US",
            "telephone_number": "704-355-9330",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1350 S Kings Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282072134",
            "country_code": "US",
            "telephone_number": "704-446-1255",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2001 Vail Ave",
            "address_2": "Ste 360",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282071248",
            "country_code": "US",
            "telephone_number": "704-304-1160",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1025 Morehead Medical Dr",
            "address_2": "Ste 300",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282042963",
            "country_code": "US",
            "telephone_number": "704-355-4593",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNELLY",
        "first_name": "MICHAEL",
        "middle_name": "J.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2088F0040X",
            "taxonomy_group": "",
            "desc": "Urology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "NC",
            "license": "9500634",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NC",
            "license": "9500634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkennelly137111@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1225 Harding Pl",
            "address_2": "Ste 3100",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282042826",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.