Individual provider Active NPI

John Spencer Kennedy, DO

  • General Practice Physician
  • Pensacola, FL
National Provider Identifier
1760076970
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
0102207361 Issued in VA
Practice address
6000 US-98
Pensacola, FL 32512-2111
Phone
(850) 505-6601
NPI assigned
Feb 28, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
General Practice Physician 208D00000X 0102207361 VA Primary

Addresses

Primary practice location

6000 US-98
Pensacola, FL 32512-2111

Mailing address

620 John Paul Jones Cir
Portsmouth, VA 23708-2111
Phone (757) 953-2339

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20210708003190 VA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 1456753755

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0102207361VAMDGeneral Practice Physician

NPI Registry JSON

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

{
    "created_epoch": "1614470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1760076970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 JOHN PAUL JONES CIR",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237082111",
            "telephone_number": "757-953-2339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 US-98",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325122111",
            "telephone_number": "850-505-6601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "JOHN",
        "middle_name": "SPENCER",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-28",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0102207361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.