NPIMap

Individual provider Active NPI

Patricia Rae Kennedy, MD

  • Surgery Physician
  • Malta, NY
National Provider Identifier
1861450439
Registry record updated Mar 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
176536 Issued in NY
Practice address
6 Medical Drive
Suite 202
Malta, NY 12020
Phone
(518) 580-2170
Fax
(518) 580-2171
NPI assigned
May 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 176536 NY Primary

Addresses

Primary practice location

6 Medical Drive
Suite 202
Malta, NY 12020

Mailing address

PO Box 1368
Albany, NY 12201-1368
Phone (518) 580-2170

Other identifiers 3

IdentifierTypeStateIssuer
000000386171OtherINANTHEM PIN
200800120MedicaidIN
02623274MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20150831000225 NY Practitioner - General Surgery 0244274538 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saratoga HospitalGroup PAC ID 6406740273, 353 clinicians

Practice addresses (Care Compare)

211 Church St
Saratoga Springs, NY 12866-1003
Phone (518) 583-8421

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
68.51 of 100Reported as group
Quality
56.19
Improvement activities
40
Cost
75.36

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy36

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Saratoga Hospital Current Accepting new patients
Saratoga Hospital Current Accepting new patients
Saratoga Hospital Current Accepting new patients
Saratoga Hospital CurrentSince Jul 15, 2015 Accepting new patients
Saratoga Hospital CurrentSince Jul 15, 2015 Accepting new patients
Saratoga Hospital Current Accepting new patients
Saratoga Hospital Past Accepting new patients
University General Surgeons, Inc. Surgery Past Accepting new patients

Locations

3040 Route 50
Saratoga Springs, NY 12866
Phone (518) 580-2170

211 Church St
Saratoga Springs, NY 12866
Phone (518) 583-8461

1 West Ave
Ste 300
Saratoga Springs, NY 12866
Phone (518) 693-4699

3044 Route 50
Saratoga Springs, NY 12866
Phone (518) 886-5800

Organizations & group practices 8

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.

Hospital & facility affiliations 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456790400000",
    "number": "1861450439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1368",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122011368",
            "telephone_number": "518-580-2170",
            "fax_number": "518-580-2171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 MEDICAL DRIVE",
            "address_2": "SUITE 202",
            "city": "MALTA",
            "state": "NY",
            "postal_code": "12020",
            "telephone_number": "518-580-2170",
            "fax_number": "518-580-2171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "PATRICIA",
        "middle_name": "RAE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-03",
        "last_updated": "2016-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "176536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000386171",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200800120",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02623274",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Malta, NY

Sources for this page

Verify at the official NPI Registry.