NPIMap

Individual provider Active NPI

Shannon Kennedy, MD

  • Internal Medicine Physician
  • Charleston, SC
National Provider Identifier
1821022302
Registry record updated Feb 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
249109 Issued in SC
Practice address
109 Wappoo Creek Dr
2A
Charleston, SC 29412-2135
Phone
(843) 737-5206
Fax
(843) 795-7171
NPI assigned
Jul 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 24910 SC
Internal Medicine Physician 207R00000X 249109 SC Primary

Addresses

Primary practice location

109 Wappoo Creek Dr
2A
Charleston, SC 29412-2135

Mailing address

109 Wappoo Creek Dr
2A
Charleston, SC 29412-2135
Phone (843) 737-5206

Other identifiers 4

IdentifierTypeStateIssuer
249109MedicaidSC
GP4841OtherSCMEDICAID GROUP #
P00700010OtherSCRAILROAD MC ID-PRIOR 5/1/09
5551OtherSCMEDICARE GROUP #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20060802000091 SC Practitioner - Internal MedicinePractitioner - Pediatric Medicine 1355354739 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
University of Nevada School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Remedy Internal Medicine and Wellness Center P aGroup PAC ID 1557523917, 3 clinicians

Practice addresses (Care Compare)

109 Wappoo Creek Dr
2A
Charleston, SC 29412-2138
Phone (843) 737-5206

Hospital & facility affiliations

  • Roper-St. Francis Home Health Home health agency, Charleston, SC, CCN 427042
  • Bon Secours-St Francis Xavier Hospital Hospital, Charleston, SC, CCN 420065
  • Roper Hospital Hospital, Charleston, SC, CCN 420087
  • Musc Medical Center Hospital, Charleston, SC, CCN 420004
  • Mount Pleasant Hospital Hospital, Mount Pleasant, SC, CCN 420104

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
249109SCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Remedy Internal Medicine and Wellness Center P a Internal Medicine CurrentSince Jan 1, 2012 Accepting new patients

Locations

109 Wappoo Creek Dr
Ste 2A
Charleston, SC 29412
Phone (843) 737-5206

3423 Maybank Hwy
Johns Island, SC 29455
Phone (843) 270-3412

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/7359/brand/1/csg/1/fhir/r4
  • Direct secure messaging: shannon.kennedy.1@7359.direct.athenahealth.com

Organizations & group practices 1

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 10

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": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361923200000",
    "number": "1821022302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 WAPPOO CREEK DR",
            "address_2": "2A",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294122135",
            "telephone_number": "843-737-5206",
            "fax_number": "843-795-7171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 WAPPOO CREEK DR",
            "address_2": "2A",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294122135",
            "telephone_number": "843-737-5206",
            "fax_number": "843-795-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-10",
        "last_updated": "2013-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "24910",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "249109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "249109",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP #",
            "identifier": "GP4841",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MC ID-PRIOR 5/1/09",
            "identifier": "P00700010",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "5551",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.