Active NPI
Eugene P. Kennedy, M.D.
- Surgery Physician
- Philadelphia, PA
National Provider Identifier
1902826274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD428122
- Practice address
- 1100 Walnut St
Mob, 5TH Floor
Philadelphia, PA 19107-5563 - Phone
- (215) 955-6750
- Fax
- (215) 923-8222
- NPI assigned
- Jul 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MD428122 | PA | Primary |
Addresses
Primary practice location
1100 Walnut St
Mob, 5TH Floor
Philadelphia, PA 19107-5563
Mailing address
615 Chestnut St
14TH Floor, Central Enrollment
Philadelphia, PA 19106-4404
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0093815 | Medicaid | NJ | |
| 101509252 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Osler Drive Emergency Physcians Associates, P.a. | Past | Accepting new patients |
Organizations & group practices 1
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 Medicine Physician
- Towson, MD
- NPI 1568421659
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306800000000",
"number": "1902826274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 CHESTNUT ST",
"address_2": "14TH FLOOR, CENTRAL ENROLLMENT",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191064404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 WALNUT ST",
"address_2": "MOB, 5TH FLOOR",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191075563",
"telephone_number": "215-955-6750",
"fax_number": "215-923-8222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "EUGENE",
"middle_name": "P.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-20",
"last_updated": "2011-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "PA",
"license": "MD428122",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0093815",
"state": "NJ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101509252",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.