Samantha Kennedy

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

129 Hedin Ave
Red Wing, MN 55066-1907

Phone

(651) 212-7429

Fax

(507) 446-0431

NPI assigned

Mar 23, 2020

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

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Group practices

Fernbrook Family Center IncGroup PAC ID 3870872914, 31 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Fernbrook Family Center, Inc

  • Social Worker
  • Owatonna, MN
  • NPI 1659483915
  Medicare reassignment Care Compare group NPD
• Fernbrook Family Center

  • Social Worker
  • Red Wing, MN
  • NPI 1437427911
  NPD (past)

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

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584921600000",
    "number": "1952938896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2575 HARVEST LN",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550604305",
            "telephone_number": "507-446-0431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 HEDIN AVE",
            "city": "RED WING",
            "state": "MN",
            "postal_code": "550661907",
            "telephone_number": "651-212-7429",
            "fax_number": "507-446-0431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "SAMANTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-23",
        "last_updated": "2020-03-23",
        "certification_date": "2020-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacalyn Anne Bossen Kawiecki, MD, MHA
• Gregory A Kays, MD
• Autumn Margaret Kelly
• Megan Kathleen Kelly
• Ryan Patrick Kelly
• Scott Philip Ketterling, D.C.
• Megan Lynn Kindom, MD
• Brittany Michele Kingston, AAS
• Nicole Kirchner, LPCC
• Curtis Francis Kline

• Professional Counselor in Red Wing, MN
• Providers in Red Wing, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2020; 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.