Gardner Thomas Kenny, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

036086011 Issued in IL

Practice address

405 W Jackson St
Carbondale, IL 62901-1462

Phone

(618) 549-0721

Fax

(618) 529-0449

NPI assigned

Aug 16, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 5

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Anesthesiology

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northstar Anesthesia of Illinois, LLCGroup PAC ID 4688893878, 404 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Herrin Hospital Hospital, Herrin, IL, CCN 140011
• Memorial Hospital of Carbondale Hospital, Carbondale, IL, CCN 140164
• St Joseph Memorial Hospital Hospital, Murphysboro, IL, CCN 141334

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gkenny14127@sih.direct-ci.com

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.

• Northstar Anesthesia of Illinois, LLC

  • Anesthesiology Physician
  • Arlington, TX
  • NPI 1962822395

  IL

  Medicare reassignment Care Compare group NPD
• Southern Illinois Medical Services, NFP

  dba SIH Medical Group

  • Internal Medicine Physician
  • Carbondale, IL
  • NPI 1770656837
  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Southern Illinois Hospital Services

  dba Memorial Hospital of Carbondale

  • General Acute Care Hospital
  • Carbondale, IL
  • NPI 1093801797
  Care Compare affiliation
• Southern Illinois Hospital Services

  dba St. Joseph Memorial Hospital

  • Critical Access Hospital
  • Murphysboro, IL
  • NPI 1356435135
  Care Compare affiliation
• Southern Illinois Hospital Services

  dba Herrin Hospital

  • General Acute Care Hospital
  • Herrin, IL
  • NPI 1528158573
  Care Compare affiliation

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638403200000",
    "number": "1851383947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3988",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023988",
            "telephone_number": "618-457-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 W JACKSON ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011462",
            "telephone_number": "618-549-0721",
            "fax_number": "618-529-0449"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 S Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Murphysboro",
            "state": "IL",
            "postal_code": "629663333",
            "country_code": "US",
            "telephone_number": "618-684-3156 x65137",
            "fax_number": "618-529-0529",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 S 14th St",
            "address_purpose": "LOCATION",
            "city": "Herrin",
            "state": "IL",
            "postal_code": "629483631",
            "country_code": "US",
            "telephone_number": "618-942-2171 x65137",
            "fax_number": "618-351-4919",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "510 Lincoln Dr",
            "address_purpose": "LOCATION",
            "city": "Herrin",
            "state": "IL",
            "postal_code": "629486334",
            "country_code": "US",
            "telephone_number": "618-997-6800 x1125",
            "fax_number": "618-993-8188",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2601 W Main St",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629011031",
            "country_code": "US",
            "telephone_number": "618-351-7300",
            "fax_number": "618-457-7890",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNY",
        "first_name": "GARDNER",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2021-12-02",
        "certification_date": "2021-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036086011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTISPECIALTY  GROUP PTAN",
            "identifier": "214881",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036086011",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gkenny14127@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "405 W Jackson St",
            "address_2": "SIH Medical Group Anesthesiologu",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62901",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gkenny14127@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "2601 W Main Street",
            "address_2": "SIH Medical Group Anesthesiology",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62901",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gkenny14127@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "2 South Hospital Drive",
            "address_2": "SIH Medical Group Anesthesiology",
            "city": "Murphysboro",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62966",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gkenny14127@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "510 Lincoln Drive",
            "address_2": "SIH Medical Group Anesthesiology",
            "city": "Herrin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62948",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gkenny14127@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "201 S 14th Street",
            "address_2": "SIH Medical Group Anesthesiology",
            "city": "Herrin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62948",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jessica C Kelley, DPT
• Jeffrey Saunders Kellogg, PSY.D
• Dina Kelly
• Constance Susan Kemp, M.D.
• Jodie Kennedy, L.C.S.W.
• Christopher Ryan Kent
• Teresa Ann Kent, LCSW, ACSW
• Emily Elise Kermicle, PA-C
• Sarah Kertz, PH.D.
• Marta Elisa Ketter, SLP M.S.

• Anesthesiology Physician in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Anesthesiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2021; 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.

Verify at the official NPI Registry.