Jay Kelly Kennard, M.D.
Individual provider Active NPI Family Medicine Physician · Oneida, WI
NPI 1851398523 · NPPES record last updated Jun 8, 2012
Key facts
- NPI
- 1851398523
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 49185-020 (WI)
- Practice address
- 525 Airport Dr
Oneida, WI 54155-9035 - Phone
- (920) 869-2711
- Fax
- (920) 869-1077
- NPI assigned
- Jul 7, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Intercare Community Health Network
Practice addresses (Care Compare)
285 James St
Holland, MI 49424-1849
Phone (616) 399-0200
800 M
Suite 139
Benton Harbor, MI 49022-3881
Phone (269) 927-5400
Hospital & facility affiliations
- Holland Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI, MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061106000004 | WI | Practitioner - Family Practice | 7911904982 | Reassigns benefits to 1 organization |
| I20241012000108 | MI | Practitioner - Family Practice | 7911904982 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35.073508 | OH | MD | Family Medicine Physician |
| 49185-020 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oneida Nation | Current |
Accepting new patients | |
| Intercare Community Health Network | Current |
Accepting new patients | |
| Intercare Community Health Network | Current |
Accepting new patients | |
| Menominee Indian Tribe of Wisconsin | Past | Accepting new patients |
Locations
308 Charles St
Bangor, MI 49013
Phone (269) 427-7967
50 Industrial Park Rd
Bangor, MI 49013
Phone (269) 427-7937
870 Colfax Ave
Benton Harbor, MI 49022
Phone (269) 605-1277
800 M 139
Benton Harbor, MI 49022
Phone (269) 927-5400
7450 Hochberger Rd
Eau Claire, MI 49111
Phone (855) 869-6900
285 James St
Holland, MI 49424
Phone (616) 399-0200
538 Washington St
Otsego, MI 49078
Phone (269) 694-7873
5498 109th Ave
Pullman, MI 49450
Phone (269) 236-5021
525 Airport Dr
Oneida, WI 54155
Phone (920) 869-2711
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35.073508 | OH | |
| Family Medicine Physician | 207Q00000X | 49185-020 | WI | Yes |
Addresses
Primary practice location
525 Airport Dr
Oneida, WI 54155-9035
Mailing address
PO Box 365
Oneida, WI 54155-0365
Phone (920) 869-2711
Other providers in Oneida, WI
- Alyssa J Hudak
- Gabriella James
- Kim E Javens
- Tina Jorgensen
- Susan L Katuin
- Kelly M Knoebel
- Dawn Krines
- Heather J Lallaman
- Mary C Lamers
- Kalyn Elizabeth Leege
All providers in Oneida, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2012. 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.
- 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.