NPIMap

Individual provider Active NPI

Robert Kennedy, MD

  • Vascular & Interventional Radiology Physician
  • West Melbourne, FL
National Provider Identifier
1740220789
Registry record updated Nov 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
ME81880 Issued in FL
Practice address
415 S Wickham Rd
West Melbourne, FL 32904-1137
Phone
(321) 400-1220
Fax
(321) 241-3000
NPI assigned
Jun 7, 2006
Last updated
Nov 3, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X ME81880 FL Primary

Addresses

Primary practice location

415 S Wickham Rd
West Melbourne, FL 32904-1137

Mailing address

2200 W Eau Gallie Blvd
200
Melbourne, FL 32935-3165
Phone (321) 253-2900

Other identifiers 1

IdentifierTypeStateIssuer
273810400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20051028000228 FL Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 3870510910 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
University of Mississippi School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Interventional and Vascular Center PLLCGroup PAC ID 5991085482, 5 clinicians

Practice addresses (Care Compare)

415 S Wickham Rd
Melbourne, FL 32904-1137
Phone (321) 400-1220

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal18
Leg revascularization (restoring blood flow)13
Removal of tissue109

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME81880FLMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Interventional & Vascular Center, PLLC Vascular & Interventional Radiology CurrentSince Nov 1, 2016 Accepting new patients
Carrollwood Diagnostic Imaging Past Accepting new patients
Sheridan Radiology Services of Central Florida, Inc. Past Accepting new patients
Tampa Bay Radiology Associates PA Vascular & Interventional Radiology PastSince May 17, 2020 Accepting new patients
Tampa Bay Radiology Consultants Past Accepting new patients

Locations

415 S Wickham Rd
West Melbourne, FL 32904
Phone (321) 400-1220

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

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 3

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": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446508800000",
    "number": "1740220789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 W EAU GALLIE BLVD",
            "address_2": "200",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329353165",
            "telephone_number": "321-253-2900",
            "fax_number": "321-435-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S WICKHAM RD",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329041137",
            "telephone_number": "321-400-1220",
            "fax_number": "321-241-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2015-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "FL",
            "license": "ME81880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273810400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Melbourne, FL

Sources for this page

Verify at the official NPI Registry.