Gregory A Kennebeck, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A63038 Issued in CA

Practice address

101 Bodin Cir
Travis Afb, CA 94535-1809

Phone

(707) 423-1110

NPI assigned

Dec 21, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH, WA2 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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Emergency Professional Services, Inc.

  • Emergency Medicine Physician
  • Seaman, OH
  • NPI 1093762353
  Medicare reassignment NPD
• Miami Valley Emergency Specialists, LLC

  • Emergency Medicine Physician
  • Dayton, OH
  • NPI 1821189085
  Medicare reassignment NPD
• Shelton SNF Operations, LLC

  • Skilled Nursing Facility
  • Shelton, WA
  • NPI 1861106049
  NPD (past)
• Willapa Nursing & Rehab LLC

  • Skilled Nursing Facility
  • Raymond, WA
  • NPI 1437869492
  NPD (past)

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369958400000",
    "number": "1871579847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2312 FAR HILLS AVE # 147",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454191512",
            "telephone_number": "937-938-3329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEBECK",
        "first_name": "GREGORY",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-21",
        "last_updated": "2013-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A63038",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A63038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick James Kearney, M.D., M.P.H.
• Patricia Leigh Keithley, DPT
• Dennis William Kelly Jr., D.D.S., M.S.
• Joseph G Kelly, DNP
• Thomas Francis Kelly, DDS
• Jason Kenyon
• Annette A Keochekian, M.D.
• Rebecca Kerber, RN
• Keri Denise Kersey, M.D.
• Tiffany Enrou Khang, LCSW

• Family Medicine Physician in Travis Afb, CA
• Providers in Travis Afb, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.