NPIMap

Individual provider Active NPI

Courtney Marie Kennel, D.O.

  • Family Medicine Physician
  • Lakewood, WA
National Provider Identifier
1912261447
Registry record updated Aug 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OP60413256 Issued in WA
Practice address
5920 100TH St SW
Suite 31
Lakewood, WA 98499-2751
Phone
(253) 584-3023
Fax
(253) 582-1222
NPI assigned
Jun 29, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OP60413256 WA Primary

Addresses

Primary practice location

5920 100TH St SW
Suite 31
Lakewood, WA 98499-2751

Mailing address

5920 100TH St SW
Suite 26C
Lakewood, WA 98499-2751
Phone (253) 830-2030

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150807014419 WA Practitioner - Family Practice 9739329483 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians
Northwest Physicians Medical Group, PLLCGroup PAC ID 3173796703, 4 clinicians

Practice addresses (Care Compare)

2600 Compass Rd
Glenview, IL 60026-8001

5920 100TH St SW
Suite 31
Lakewood, WA 98499-2751
Phone (253) 584-3023

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Physicians Medical Group, PLLC Family Medicine CurrentSince Jun 15, 2015 Accepting new patients

Locations

32124 1st Ave S
Ste 300
Federal Way, WA 98003
Phone (253) 941-0673

5920 100th St SW
Ste 30
Lakewood, WA 98499
Phone (253) 584-1700

5920 100th St SW
Ste 31
Lakewood, WA 98499
Phone (253) 584-3023

Interoperability endpoints

  • Direct secure messaging: courtneykennel@direct.meditouchehr.com

Organizations & group practices 2

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.

Hospital & facility affiliations 10

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": "1340928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439856000000",
    "number": "1912261447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5920 100TH ST SW",
            "address_2": "SUITE 26C",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984992751",
            "telephone_number": "253-830-2030",
            "fax_number": "253-830-2055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5920 100TH ST SW",
            "address_2": "SUITE 31",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984992751",
            "telephone_number": "253-584-3023",
            "fax_number": "253-582-1222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEL",
        "first_name": "COURTNEY",
        "middle_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-29",
        "last_updated": "2015-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP60413256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, WA

Sources for this page

Verify at the official NPI Registry.