NPIMap

Individual provider Active NPI

Nathan Timothy Kenyon, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Jefferson City, MO
National Provider Identifier
1851651657
Registry record updated Feb 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
2013018167 Issued in MO
Practice address
2505 Mission Dr Ste 200
Jefferson City, MO 65109-9508
Phone
(573) 681-3759
Fax
(573) 681-3659
NPI assigned
May 25, 2012
Last updated
Feb 22, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 22, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 2013018167 MO Primary

Addresses

Primary practice location

2505 Mission Dr Ste 200
Jefferson City, MO 65109-9508

Mailing address

2505 Mission Dr Ste 200
Jefferson City, MO 65109-9508
Phone (573) 681-3759

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
I20170714002288 MO Practitioner - Physical Medicine and Rehabilitation 3274768494 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
SSM Regional Health ServicesGroup PAC ID 8921917352, shared by 13 NPIs, 165 clinicians

Practice addresses (Care Compare)

2505 Mission Dr
Suite 200
Jefferson City, MO 65109-9508
Phone (573) 681-3759

875 S Hwy 5
Tipton, MO 65081-8441
Phone (660) 433-5541

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.07 of 100Reported as group
Quality
86.39
Promoting interoperability
100
Improvement activities
40
Cost
73.83

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2013018167MOMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Regional Health Services CurrentSince Aug 7, 2017 Accepting new patients
SSM Regional Health Services CurrentSince May 1, 2021 Accepting new patients
Putnam County Memorial Hospital Current Accepting new patients
SSM Regional Health Services Past Accepting new patients
Putnam County Memorial Hospital Past Accepting new patients

Locations

7655 Solutions Ctr
Chicago, IL 60677

875 S Highway 5
Tipton, MO 65081
Phone (660) 433-5404

1926 Oak St
Unionville, MO 63565
Phone (660) 785-1834

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/putnamm-2b5c1bdb
  • Direct secure messaging: nkenyon206876@direct-ehr-ssmhc.com

Organizations & group practices 5

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": "1337904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519257600000",
    "number": "1851651657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2505 MISSION DR STE 200",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651099508",
            "telephone_number": "573-681-3759",
            "fax_number": "573-681-3659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 MISSION DR STE 200",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651099508",
            "telephone_number": "573-681-3759",
            "fax_number": "573-681-3659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENYON",
        "first_name": "NATHAN",
        "middle_name": "TIMOTHY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-25",
        "last_updated": "2018-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MO",
            "license": "2013018167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson City, MO

Sources for this page

Verify at the official NPI Registry.