Active NPI
Timothy Alan Kennedy, PH.D., L.I.S.W.
- Clinical Social Worker
- Worthington, OH
National Provider Identifier
1790830610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I-492
- Practice address
- 6827 N High St
121
Worthington, OH 43085-2517 - Phone
- (614) 436-5070
- NPI assigned
- Jan 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | I-492 | OH | Primary |
Addresses
Primary practice location
6827 N High St
121
Worthington, OH 43085-2517
Mailing address
9468 Cheshire Rd
Sunbury, OH 43074-9543
Phone (740) 965-2145
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120301000355 | OH | Practitioner - Clinical Social Worker | 5395903876 | Practice locations: Westerville, OH |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1978
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
519 S Otterbein Ave
Suite 4
Westerville, OH 43081-2953
Phone (740) 972-0244
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I-492 | OH | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790830610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9468 CHESHIRE RD",
"city": "SUNBURY",
"state": "OH",
"postal_code": "430749543",
"telephone_number": "740-965-2145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6827 N HIGH ST",
"address_2": "121",
"city": "WORTHINGTON",
"state": "OH",
"postal_code": "430852517",
"telephone_number": "614-436-5070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "TIMOTHY",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "PH.D., L.I.S.W.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "I-492",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Worthington, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.