Emmet Michael Kenney Jr., MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

ND7174 Issued in ND

Practice address

3201 33Rd St S
Fargo, ND 58104-8823

Phone

(701) 365-4488

Fax

(701) 365-0727

NPI assigned

Sep 28, 2006

Last updated

Apr 30, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ND

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 1

Specialty

Psychiatry

Education

Creighton University School of Medicine, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

St. Sophie's LLCGroup PAC ID 7113195074, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• St. Sophie's, LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Fargo, ND
  • NPI 1336443654
  Medicare reassignment Care Compare group
• Prairie St Johns

  • Psychiatric Hospital
  • Fargo, ND
  • NPI 1417901000
  NPD (past) Authorized official
• St James of ND, LLC

  • Adult Mental Health Clinic/Center
  • Bismarck, ND
  • NPI 1538463401
  NPD (past) Authorized official
• St Sophie's, LLC

  dba St Sophie's Bismarck

  • Psychiatry Physician
  • Bismarck, ND
  • NPI 1679916621
  NPD (past) Authorized official
• St. Sophie's, LLC

  • Adult Mental Health Clinic/Center
  • Paradise Valley, AZ
  • NPI 1336415942
  NPD (past) Authorized official

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398816000000",
    "number": "1902998081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201 33RD ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048823",
            "telephone_number": "701-365-4488",
            "fax_number": "701-365-0727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 33RD ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048823",
            "telephone_number": "701-365-4488",
            "fax_number": "701-365-0727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEY",
        "first_name": "EMMET",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2014-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ND",
            "license": "ND7174",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "MN32170",
            "primary": false
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "ND",
            "license": "ND7174",
            "primary": false
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "MN",
            "license": "MN32170",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "ND",
            "license": "ND7174",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MN",
            "license": "MN32170",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "597823800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "22028",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18353",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Philip Kennedy, M.D.
• Kennelly Speech Language Pathology LTD (Onword therapy)
• Nanette S Kennelly, MS CCC-SLP
• Shelley K Kenner
• Brooks Robert Kenney
• Randall A Kenninger, MD
• Meredith J Kenow, LPC
• Daniel Kensok
• Shari Lyn Kensok, OD
• Brittney Kenyon

• Child & Adolescent Psychiatry Physician in Fargo, ND
• Providers in Fargo, ND by specialty
• Child & Adolescent Psychiatry Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; 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.