Individual provider Active NPI

Gregory G Kenien, MD

  • Cardiovascular Disease Physician
  • Fayetteville, NY
National Provider Identifier
1770582843
Registry record updated Sep 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
168165 Issued in NY
Practice address
510 Towne Dr
Fayetteville, NY 13066-1331
Phone
(315) 663-0500
Fax
(315) 663-0514
NPI assigned
Jul 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 168165 NY Primary

Addresses

Primary practice location

510 Towne Dr
Fayetteville, NY 13066-1331

Mailing address

510 Towne Dr
Fayetteville, NY 13066-1331
Phone (315) 663-0500

Other identifiers 1

IdentifierTypeStateIssuer
00984932MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20080425000426 NY Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 5092600296 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

510 Towne Dr
Fayetteville, NY 13066-1331
Phone (315) 663-0500

5112 W Taft Rd
Suite J
Liverpool, NY 13088-4866
Phone (315) 701-2170

750 E Adams St
Syracuse, NY 13210-2306
Phone (315) 464-4457

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Department of Medicine Medical Service Group CurrentSince Sep 26, 2019 Accepting new patients
St Josephs Hospital Health Center CurrentSince Oct 1, 2000 Accepting new patients
St Josephs Medical PC CurrentSince Dec 1, 2016 Accepting new patients
Department of Medicine Medical Serv GRP at Suny HLTH Sci Ctr Syr in Cardiovascular Disease CurrentSince Sep 26, 2019 Accepting new patients
North Medical PC Current Accepting new patients
St Joseph'S Hospital Health Center CurrentSince Oct 1, 2000 Accepting new patients
S J H Cardiac Catheterization Associates PC Cardiovascular Disease Past Accepting new patients

Locations

6221 State Route 31
Ste 104
Cicero, NY 13039
Phone (315) 698-4888

6221 State Route 31
Ste 10
Cicero, NY 13039

510 Towne Dr
Fayetteville, NY 13066
Phone (315) 637-4747

4507 Medical Center Dr
Fayetteville, NY 13066
Phone (315) 637-7100

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

5112 W Taft Rd
Ste J
Liverpool, NY 13088
Phone (315) 701-2170

301 Prospect Ave
Syracuse, NY 13203
Phone (315) 448-5111

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

301 Prospect Ave
Ste 706
Syracuse, NY 13203
Phone (315) 703-5200

Interoperability endpoints

  • Direct secure messaging: gkenien95575@direct.upstate.edu

Organizations & group practices 7

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 1

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": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569542400000",
    "number": "1770582843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 TOWNE DR",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130661331",
            "telephone_number": "315-663-0500",
            "fax_number": "315-663-0514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 TOWNE DR",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130661331",
            "telephone_number": "315-663-0500",
            "fax_number": "315-663-0514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENIEN",
        "first_name": "GREGORY",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2019-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "168165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00984932",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NY

Sources for this page

Verify at the official NPI Registry.