Jay Kelly Kennard, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

49185-020 Issued in WI

Practice address

525 Airport Dr
Oneida, WI 54155-9035

Phone

(920) 869-2711

Fax

(920) 869-1077

NPI assigned

Jul 7, 2005

Last updated

Jun 8, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, MI2 enrollments

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 2

Specialty

Family Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Intercare Community Health NetworkGroup PAC ID 9537061254, 18 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Holland Hospital Hospital, Holland, MI, CCN 230072

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Intercare Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Bangor, MI
  • NPI 1326058512
  Medicare reassignment Care Compare group NPD
• Oneida Nation

  • Clinic/Center
  • Oneida, WI
  • NPI 1740278308
  Medicare reassignment NPD
• Intercare Community Health Network

  dba InterCare Child and Adolescent Behavioral Health Center

  • Federally Qualified Health Center (FQHC)
  • Eau Claire, MI
  • NPI 1336701119
  NPD
• Menominee Indian Tribe of Wisconsin

  dba Menominee Tribal Rescue Service

  • Ambulance
  • Keshena, WI
  • NPI 1508808643
  NPD (past)

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

• Holland Community Hospital

  dba Holland Hospital

  • General Acute Care Hospital
  • Holland, MI
  • NPI 1871672618
  Care Compare affiliation

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339113600000",
    "number": "1851398523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 365",
            "city": "ONEIDA",
            "state": "WI",
            "postal_code": "541550365",
            "telephone_number": "920-869-2711",
            "fax_number": "920-869-1077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 AIRPORT DR",
            "city": "ONEIDA",
            "state": "WI",
            "postal_code": "541559035",
            "telephone_number": "920-869-2711",
            "fax_number": "920-869-1077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNARD",
        "first_name": "JAY",
        "middle_name": "KELLY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2012-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.073508",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "49185-020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa J Hudak, RD CD
• Gabriella James, PA-C
• Kim E Javens, PTA
• Tina Jorgensen, MS, RDN, CD
• Susan L Katuin, RNC APNP
• Kelly M Knoebel, RDN
• Dawn Krines, BS
• Heather J Lallaman, RDH
• Mary C Lamers, RPH
• Kalyn Elizabeth Leege, PTA

• Family Medicine Physician in Oneida, WI
• Providers in Oneida, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2012; 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.