Individual provider Active NPI

Robert J Kennedy, MD

  • Ophthalmology Physician
  • Schenectady, NY
National Provider Identifier
1801817424
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
1589361 Issued in NY
Practice address
1675 Providence Avenue
Schenectady, NY 12309
Phone
(518) 377-3439
NPI assigned
Jul 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 1589361 NY Primary

Addresses

Primary practice location

1675 Providence Avenue
Schenectady, NY 12309

Mailing address

1675 Providence Avenue
Schenectady, NY 12309
Phone (518) 377-3439

Other identifiers 4

IdentifierTypeStateIssuer
000405575002OtherBS
00864755MedicaidNY
10001042OtherCDPHP
17111OtherMVP

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
I20040211001013 NY Practitioner - Ophthalmology 2163315615 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Georgetown University School of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kennedy Ophthalmic Associates PLLCGroup PAC ID 6002709557, 2 clinicians

Practice addresses (Care Compare)

1675 Providence Ave
Schenectady, NY 12309-3919
Phone (518) 377-3439

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1589361NYMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy Ophthalmology Associates PLLC Ophthalmology CurrentSince Apr 1, 2000 Accepting new patients
Kennedy Ophthalmic Associates PLLC Ophthalmology PastSince Aug 1, 2000 Accepting new patients

Locations

1675 Providence Ave
Schenectady, NY 12309
Phone (518) 377-3410

Interoperability endpoints

  • Direct secure messaging: rkennedy834602@direct.trinity-health.org
  • Direct secure messaging: robert.kennedy@kennedyophthalmologyassociates.chartmakerdirect.com
  • Direct secure messaging: rkennedy@kennedyophthalmology.direct.eyemdemr.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801817424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 PROVIDENCE AVENUE",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "12309",
            "telephone_number": "518-377-3439",
            "fax_number": "518-377-0436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 PROVIDENCE AVENUE",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "12309",
            "telephone_number": "518-377-3439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "ROBERT",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "1589361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS",
            "identifier": "000405575002",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00864755",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "10001042",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "17111",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Schenectady, NY

Sources for this page

Verify at the official NPI Registry.