Individual provider Active NPI

Elijah Kennedy, M.D.

  • Emergency Medicine Physician
  • Orlando, FL
National Provider Identifier
1851746135
Registry record updated May 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
ME136445 Issued in FL
Practice address
7727 Lake Underhill Rd
Department of Emergency Medicine
Orlando, FL 32822-8224
Phone
(407) 303-6413
NPI assigned
Apr 25, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X ME136445 FL Primary

Addresses

Primary practice location

7727 Lake Underhill Rd
Department of Emergency Medicine
Orlando, FL 32822-8224

Mailing address

5870 Hiatus Rd
Tamarac, FL 33321-6424
Phone (800) 424-3672

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, TN, GA3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20190626001098 FL Practitioner - Emergency Medicine 2466786306 Reassigns benefits to 1 organization
I20230822000434 TN Practitioner - Emergency Medicine 2466786306 Reassigns benefits to 1 organization
I20230925002547 GA Practitioner - Emergency Medicine 2466786306 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME136445FLMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chattanooga Emergency Medicine PLLC CurrentSince Jul 10, 2023 Accepting new patients
Florida Emergency Physicians Kang and Associates MD LLC Emergency Medicine CurrentSince Jul 1, 2019 Accepting new patients
Chattanooga Emergency Medicine PLLC Current Accepting new patients

Locations

7727 Lk Under Hl
Orlando, FL 32822
Phone (407) 303-6413

601 E Rollins St
Orlando, FL 32803
Phone (407) 303-1996

5870 N Hiatus Rd
Tamarac, FL 33321
Phone (957) 377-2954

1000 Waterman Way
Tavares, FL 32778
Phone (352) 253-3333

100 Gross Crescent Cir
Ft Oglethorpe, GA 30742
Phone (706) 858-2301

2525 Desales Ave
Chattanooga, TN 37404
Phone (423) 495-2620

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1461542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557619200000",
    "number": "1851746135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5870 HIATUS RD",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333216424",
            "telephone_number": "800-424-3672",
            "fax_number": "954-377-3042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7727 LAKE UNDERHILL RD",
            "address_2": "DEPARTMENT OF EMERGENCY MEDICINE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328228224",
            "telephone_number": "407-303-6413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "ELIJAH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-25",
        "last_updated": "2019-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME136445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.