Kennedy Marie Isaak, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2023014817 Issued in MO

Practice address

621 S New Ballas Rd Ste 63B
Saint Louis, MO 63141-8251

Phone

(314) 960-8771

NPI assigned

Jan 4, 2022

Last updated

Apr 1, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Clinic Childrens Surgery LLCGroup PAC ID 4385076199, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: kennedy.tiefenbrunn@mercy.net

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.

• Mercy Clinic Children's Surgery, LLC

  • Pediatric Surgery Physician
  • Saint Louis, MO
  • NPI 1649349804
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1641254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711929600000",
    "number": "1871254615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 INWOOD CT",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633762613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 63B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418251",
            "telephone_number": "314-960-8771"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12700 Southfork Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631283201",
            "country_code": "US",
            "telephone_number": "314-251-3500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ISAAK",
        "first_name": "KENNEDY",
        "middle_name": "MARIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-04",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2023014817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kennedy.tiefenbrunn@health.slu.edu",
            "affiliation": "N",
            "address_1": "3437 Caroline St",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631041111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Kennedy.tiefenbrunn@mercy.net",
            "affiliation": "Y",
            "affiliationName": "Mercy Saint Louis",
            "address_1": "621 S New Ballas Rd Ste 63B",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631418251",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stephen Edward Irwin, MD
• Thomas L Irwin Jr., MSW, LCSW
• Alexandra Isaac
• Cierra Angelina Isaac
• Megan Lindsey Isaacson-Schmid, PA-C
• Taylor Michelle Isaak, DMD
• Kendra Isadore
• Latonya Isaiah
• Isaiah's Angels LLC
• Kateryna Yuriivna Isaieva

• Physician Assistant in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.