Active NPI
Michael Patrick Kennedy, MD
- Family Medicine Physician
- Carencro, LA
National Provider Identifier
1972514800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD018238
- Practice address
- 111 Saint Charles St
Carencro, LA 70520-4004 - Phone
- (337) 886-1200
- Fax
- (337) 886-0919
- NPI assigned
- Aug 9, 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD018238 | LA | Primary |
Addresses
Primary practice location
111 Saint Charles St
Carencro, LA 70520-4004
Mailing address
111 Saint Charles St
Carencro, LA 70520-0000
Phone (337) 886-1200
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7299329 | Other | AETNA | |
| 10990532 | Other | CAQH | |
| 1377104 | Medicaid | LA | |
| F4181 | Other | LA | BLUE CROSS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD018238 | LA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fielder Family Clinic LLC | 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.
-
- Family Nurse Practitioner
- Carencro, LA
- NPI 1073059945
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260316800000",
"number": "1972514800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 SAINT CHARLES ST",
"city": "CARENCRO",
"state": "LA",
"postal_code": "705200000",
"telephone_number": "337-886-1200",
"fax_number": "337-886-0919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 SAINT CHARLES ST",
"city": "CARENCRO",
"state": "LA",
"postal_code": "705204004",
"telephone_number": "337-886-1200",
"fax_number": "337-886-0919"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "MICHAEL",
"middle_name": "PATRICK",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2009-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "LA",
"license": "MD018238",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7299329",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "10990532",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1377104",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "F4181",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Carencro, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.