Individual provider Active NPI

Priscilla Kennedy, DO

  • Internal Medicine Physician
  • Salem, VA
National Provider Identifier
1972131399
Registry record updated Dec 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0102207974 Issued in VA
Practice address
1900 Electric Rd
Salem, VA 24153-7474
Phone
(540) 577-5874
NPI assigned
Mar 31, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 0102207974 VA Primary

Addresses

Primary practice location

1900 Electric Rd
Salem, VA 24153-7474

Mailing address

1900 Electric Rd
Salem, VA 24153-7474

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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

Enrollment IDStateProvider typePAC IDDetails
I20230719003222 VA Practitioner - Internal Medicine 5799145975 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Edward Via Col of Osteo Medicine-Carolinas Campus, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Spring Physician Services, LLCGroup PAC ID 1254689482, 89 clinicians

Practice addresses (Care Compare)

1900 Electric Rd
Salem, VA 24153-7474
Phone (540) 776-4000

Hospital & facility affiliations

  • Lewisgale Medical Center Hospital, Salem, VA, CCN 490048

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0102207974VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Spring Physician Services, LLC CurrentSince Jun 15, 2023 Accepting new patients

Locations

200 Corporate Blvd
Lafayette, LA 70508

1900 Electric Rd
Salem, VA 24153
Phone (540) 772-3400

Interoperability endpoints

  • Direct secure messaging: priscilla.fujikawa@hca6.eclinicaldirectplus.com

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.

Hospital & facility affiliations 1

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": "1585612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1972131399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 ELECTRIC RD",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "241537474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 ELECTRIC RD",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "241537474",
            "telephone_number": "540-577-5874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "PRISCILLA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-31",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0102207974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, VA

Sources for this page

Verify at the official NPI Registry.