NPIMap

Individual provider Active NPI

Jerone Danuel Kennedy, MD

  • Neurological Surgery Physician
  • Saint Cloud, MN
National Provider Identifier
1780644401
Registry record updated Mar 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
39807 Issued in MN
Practice address
1200 6TH Ave N
Centracare Clinic
Saint Cloud, MN 56303-2735
Phone
(757) 388-6115
Fax
(757) 388-6116
NPI assigned
Mar 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 0101254590 VA
Neurological Surgery Physician 207T00000X 39807 MN Primary

Addresses

Primary practice location

1200 6TH Ave N
Centracare Clinic
Saint Cloud, MN 56303-2735

Mailing address

1200 6TH Ave N
Centracare Clinic
Saint Cloud, MN 56303-2735
Phone (320) 240-2829

Other identifiers 2

IdentifierTypeStateIssuer
53379020OtherWIWISCONSIN MEDICAL BOARD
39807OtherMNMINNESOTA BOARD OF MEDICINE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jkennedy193732@direct.centracare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20050510000151 MN Practitioner - Neurosurgery 0941293377 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Stanford University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1200 6TH Ave N
Saint Cloud, MN 56303-2735

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

1406 6TH Ave N
St Cloud, MN 56303-1901

1406 6TH Ave No
St Cloud, MN 56303-1901

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion60
Laminectomy or laminotomy (partial removal of spine bones)23

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39807MNMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic CurrentSince Sep 14, 2014 Accepting new patients
Centracare Clinic CurrentSince Sep 14, 2014 Accepting new patients
Centracare Clinic Current Accepting new patients
Centracare Clinic Past Accepting new patients
Centracare Clinic Past Accepting new patients
St. Cloud Hospital Past Accepting new patients
Allina Health System Past Accepting new patients

Locations

1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

Interoperability endpoints

  • Direct secure messaging: jkennedy193732@direct.centracare.com

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 12

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": "1143244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679875200000",
    "number": "1780644401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 6TH AVE N",
            "address_2": "CENTRACARE CLINIC",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-240-2829",
            "fax_number": "757-388-6116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 6TH AVE N",
            "address_2": "CENTRACARE CLINIC",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "757-388-6115",
            "fax_number": "757-388-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "JERONE",
        "middle_name": "DANUEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-25",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "VA",
            "license": "0101254590",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "MN",
            "license": "39807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN MEDICAL BOARD",
            "identifier": "53379020",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA BOARD OF MEDICINE",
            "identifier": "39807",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jkennedy193732@direct.centracare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jkennedy193732@direct.centracare.com",
            "address_1": "1200 6th Ave N",
            "address_2": "CentraCare Clinic",
            "city": "Saint Cloud",
            "state": "MN",
            "country_code": "US",
            "postal_code": "563032735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.