NPIMap

Individual provider Active NPI

Jerry D Kennett, M.D.

  • Cardiovascular Disease Physician
  • Columbia, MO
National Provider Identifier
1851383145
Registry record updated Jul 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
R5649 Issued in 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
Last updated
Jul 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X R5649 MO Primary

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 1

TypeEndpointUseAffiliation
Direct Messaging Address jerry.kennett@mcs.direct.gemmsnet.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20051220000793 MO Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 8628090560 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
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 LLCGroup PAC ID 7810038064, 25 clinicians

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

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R5649MOMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chas Physician Services, LLC CurrentSince Jan 1, 2011 Accepting new patients
Chas Physician Services LLC Cardiovascular Disease CurrentSince Jan 1, 2011 Accepting new patients
Blessing Walk-in Clinic LLC PastSince Dec 1, 2016 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000

1600 E Broadway
#C
Columbia, MO 65201

1600 E Broadway
#I
Columbia, MO 65201

1605 E Broadway
Ste 300
Columbia, MO 65201
Phone (573) 256-7700

404 Providence Rd
Macon, MO 63552
Phone (660) 395-8914

300 N Morley St
Moberly, MO 65270
Phone (660) 263-0909

Interoperability endpoints

  • Direct secure messaging: jerry.kennett@mcs.direct.gemmsnet.com

Ownership & related parties

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Boone Hospital CenterColumbia, MO, CCN 260068 Hospital Corporate Officer
Corporate Director
Operational/Managerial Control		 Apr 1, 2021
Apr 1, 2021
Apr 1, 2021
Boone Hospital CenterColumbia, MO, CCN 26T068 Hospital Corporate Officer
Corporate Director
Operational/Managerial Control		 Apr 1, 2021
Apr 1, 2021
Apr 1, 2021
Hamilton Warsaw ClinicWarsaw, IL, CCN 148957 Rural health clinic Corporate Director Jan 29, 2014
Boone Health Primary Care - MoberlyMoberly, MO, CCN 793868 Rural health clinic Corporate Director Apr 1, 2024
Boone Health Primary Care - Medical ParkMexico, MO, CCN 793867 Rural health clinic Corporate Director Apr 1, 2024
Boone Health Primary Care - BoonvilleBoonville, MO, CCN 793869 Rural health clinic Corporate Director Apr 1, 2024

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "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

Sources for this page

Verify at the official NPI Registry.