Colin Frank Kennedy, PA-C
Individual provider Active NPI Physician Assistant · Rockledge, FL
NPI 1770163933 · NPPES record last updated Aug 3, 2023
Key facts
- NPI
- 1770163933
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA9114032 (FL)
- Practice address
- 220 Barton Blvd Unit C-14
Rockledge, FL 32955-2742 - Phone
- (321) 241-6800
- Fax
- (321) 241-6890
- NPI assigned
- Apr 12, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 20
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Brevard Health Alliance Inc
Practice addresses (Care Compare)
17 Silver Palm Ave
Melbourne, FL 32901-3123
Phone (321) 241-6800
220 Barton Blvd
Unit C 14
Rockledge, FL 32955-2742
Phone (321) 241-6800
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210817002316 | FL | Practitioner - Physician Assistant | 0345645156 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9114032 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brevard Health Alliance Inc | Past | Accepting new patients |
Interoperability endpoints
- colin.kennedy@bha.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9114032 | FL | Yes |
Addresses
Primary practice location
220 Barton Blvd Unit C-14
Rockledge, FL 32955-2742
Mailing address
PO Box 1137
Melbourne, FL 32902-1137
Phone (321) 952-9696
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 111121400 | Medicaid | FL |
Other providers in Rockledge, FL
- Alice Keene
- Rachel Kelly
- Regina Y Kelly
- Brookelynn K Kendrick
- Christian Adam Kendrick
- Jillian Kennedy
- John C Kennedy
- Renee Nicole Kennedy
- Kenneth W Korey MD PA
- Elizabeth M Kent
All providers in Rockledge, FL · Physician Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.