Individual provider Active NPI

Kennedy M Dickhoff, CRNP

  • Nurse Practitioner
  • Hummelstown, PA
National Provider Identifier
1871129635
Registry record updated Mar 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
SP021627 Issued in PA
Practice address
1135 Old West Chocolate Avenue
Suite 101
Hummelstown, PA 17036
Phone
(717) 531-7010
Fax
(717) 531-7102
NPI assigned
Mar 12, 2020
Last updated
Mar 12, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X SP021627 PA Primary

Addresses

Primary practice location

1135 Old West Chocolate Avenue
Suite 101
Hummelstown, PA 17036

Mailing address

PO Box 858 MC A410
Hershey, PA 17033-0858
Phone (800) 243-1455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200505000585 PA Practitioner - Nurse Practitioner 3274964358 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1135 Olde W Chocolate Ave
PS Hershey Health Rehabilitation
Hummelstown, PA 17036-9188
Phone 7175310003280757

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.85 of 100Reported as group
Quality
65.84
Promoting interoperability
100
Improvement activities
40
Cost
77

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Milton S Hershey Medical Center Physician Group CurrentSince Apr 27, 2020 Accepting new patients
Penn State Health Medical Group, LLC CurrentSince Jul 17, 2022 Accepting new patients
Penn State Health Medical Group, LLC CurrentSince Jul 17, 2022 Accepting new patients
The Milton S Hershey Medical Center Physicians Group CurrentSince Apr 27, 2020 Accepting new patients
The Milton S Hershey Medical Center Physicians Group Current Accepting new patients
Penn State Health Medical Group, LLC Current Accepting new patients

Locations

1120 Cocoa Ave
Hershey, PA 17033
Phone (717) 533-4141

500 University Dr
#A410
Hershey, PA 17033
Phone (717) 531-8131

1135 Olde W Chocolate Ave
Hummelstown, PA 17036
Phone (717) 531-7010

1135 Olde W Chocolate Ave
#101
Hummelstown, PA 17036
Phone (717) 531-7010

1020 N Union St
Middletown, PA 17057
Phone (717) 795-0457

Organizations & group practices 6

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 3

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": "1583971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583971200000",
    "number": "1871129635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 858 MC A410",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170330858",
            "telephone_number": "800-243-1455",
            "fax_number": "717-531-7102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 OLD WEST CHOCOLATE AVENUE",
            "address_2": "SUITE 101",
            "city": "HUMMELSTOWN",
            "state": "PA",
            "postal_code": "17036",
            "telephone_number": "717-531-7010",
            "fax_number": "717-531-7102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKHOFF",
        "first_name": "KENNEDY",
        "middle_name": "M",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-12",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP021627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hummelstown, PA

Sources for this page

Verify at the official NPI Registry.