Jerry D Kennett, M.D.
Individual provider Active NPI Cardiovascular Disease Physician · Columbia, MO
NPI 1851383145 · NPPES record last updated Jul 28, 2023
Key facts
- NPI
- 1851383145
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- R5649 (MO)
- Practice address
- 1605 E Broadway Ste 300
Columbia, MO 65201-8023 - Phone
- (573) 256-7700
- Fax
- (573) 256-3003
- NPI assigned
- Aug 22, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 9
Owned or controlled facilities with NPI records 7
Medicare Care Compare profile
- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- University of Missouri, Columbia School of Medicine, 1973
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Chas Physician Services LLC
Practice addresses (Care Compare)
1600 E Broadway
Columbia, MO 65201-5844
1605 E Broadway
Columbia, MO 65201-8023
Phone (573) 256-7700
300 N Morley St
Suite D H
Moberly, MO 65270-2334
Phone (660) 263-7425
404 Providence Rd
Macon, MO 63552-4222
Phone (660) 395-8914
Hospital & facility affiliations
- Boone Hospital Center
- Bothwell Regional Health Center
- University of Missouri Health Care
- Lake Regional Health System
- Macon County Samaritan Memorial Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 6
| Facility | Type | Role | Since |
|---|---|---|---|
| Boone Hospital Center |
Hospital | Corporate Officer Corporate Director Operational/Managerial Control |
Apr 1, 2021 Apr 1, 2021 Apr 1, 2021 |
| Boone Hospital Center |
Hospital | Corporate Officer Corporate Director Operational/Managerial Control |
Apr 1, 2021 Apr 1, 2021 Apr 1, 2021 |
| Hamilton Warsaw Clinic |
Rural health clinic | Corporate Director | Jan 29, 2014 |
| Boone Health Primary Care - Moberly |
Rural health clinic | Corporate Director | Apr 1, 2024 |
| Boone Health Primary Care - Medical Park |
Rural health clinic | Corporate Director | Apr 1, 2024 |
| Boone Health Primary Care - Boonville |
Rural health clinic | Corporate Director | Apr 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051220000793 | MO | Practitioner - Cardiovascular Disease (Cardiology) |
8628090560 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R5649 | MO | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chas Physician Services, LLC | Current |
Accepting new patients | |
| Chas Physician Services LLC | Cardiovascular Disease | Current |
Accepting new patients |
| Blessing Walk-in Clinic LLC | Past |
Accepting new patients | |
| Ozarks Medical Center | Past | Accepting new patients |
Locations
1600 E Broadway
#I
Columbia, MO 65201
1605 E Broadway
Ste 300
Columbia, MO 65201
Phone (573) 256-7700
1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000
1600 E Broadway
#C
Columbia, MO 65201
404 Providence Rd
Macon, MO 63552
Phone (660) 395-8914
300 N Morley St
Moberly, MO 65270
Phone (660) 263-0909
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | R5649 | MO | Yes |
Addresses
Primary practice location
1605 E Broadway Ste 300
Columbia, MO 65201-8023
Mailing address
1605 E Broadway
Suite 300
Columbia, MO 65201-8023
Phone (573) 256-7700
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jerry.kennett@mcs.direct.gemmsnet.com | Health Information Exchange (HIE) |
NPI Registry JSON
{
"created_epoch": "1124668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690502400000",
"number": "1851383145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1605 E BROADWAY",
"address_2": "SUITE 300",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652018023",
"telephone_number": "573-256-7700",
"fax_number": "573-256-3071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1605 E BROADWAY STE 300",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652018023",
"telephone_number": "573-256-7700",
"fax_number": "573-256-3003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNETT",
"first_name": "JERRY",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-22",
"last_updated": "2023-07-28",
"certification_date": "2023-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "MO",
"license": "R5649",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jerry.kennett@mcs.direct.gemmsnet.com",
"affiliation": "N",
"endpointDescription": "Direct Messaging Address",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Direct Messaging Address",
"address_1": "1605 E Broadway Ste 300",
"city": "Columbia",
"state": "MO",
"country_code": "US",
"postal_code": "652018023",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Columbia, MO
- Justin Michael Kendall
- Josie Mae Kendrick
- Brian Joseph Kenkel
- Devin Kennedy
- Jamie Nicole Kennedy
- William Kenney
- Kent E. Studer OD, PC
- Keith Kenter
- Lynn Evette Keplinger
- Diana Keratishvili
All providers in Columbia, MO · Cardiovascular Disease Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.