Jasiri Kennedy, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

A81294 Issued in CA

Practice address

1325 Broadway St
Rockport, TX 78382-3333

Phone

(361) 729-0646

Fax

(361) 729-8854

NPI assigned

Jan 23, 2006

Last updated

Dec 19, 2008By 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 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA, IL, NV3 enrollments

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 3

Specialty

Emergency MedicineAlso: Family Practice

Education

University of California, Davis School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Inyo Healthcare DistrictGroup PAC ID 7911816731, 24 clinicians

Community Medical Team Acute Care CorporationGroup PAC ID 4587002290, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mark Twain Medical Center Hospital, San Andreas, CA, CCN 051332
• Southern Inyo Hospital Hospital, Lone Pine, CA, CCN 051302
• Fairfield Memorial Hospital 1 Hospital, Fairfield, IL, CCN 141311
• Northern Inyo Hospital Hospital, Bishop, CA, CCN 051324

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/11356/brand/1/csg/161/fhir/r4
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: jkennedy@yourcarecommunity.org

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.

• Community Medical Team Acute Care Corporation

  dba Community Medical Team Inc

  • Emergency Medicine Physician
  • San Andreas, CA
  • NPI 1366210478
  Medicare reassignment Care Compare group NPD
• Southern Inyo Healthcare District

  • Critical Access Hospital
  • Lone Pine, CA
  • NPI 1831128602
  Medicare reassignment Care Compare group NPD
• Clinic Services of California Medical Group Inc

  • Emergency Medicine Physician
  • Lodi, CA
  • NPI 1578958450
  Medicare reassignment NPD
• Fairfield Memorial Hospital Association

  dba Horizon Healthcare

  • Family Medicine Physician
  • Fairfield, IL
  • NPI 1649442419
  Medicare reassignment NPD
• Midwest Emergency Good Samaritan, Inc

  • Emergency Medicine Physician
  • Mount Vernon, IL
  • NPI 1629367578
  Medicare reassignment NPD
• South Lyon Health Center, Inc.

  dba South Lyon Medical Center

  • Critical Access Hospital
  • Yerington, NV
  • NPI 1376917302
  Medicare reassignment NPD
• South Lyon Health Center, Inc.

  dba South Lyon Medical Center

  • General Acute Care Hospital
  • Yerington, NV
  • NPI 1932160363
  Medicare reassignment NPD
• Team Physicians of California Medical Group Inc

  • Emergency Medicine Physician
  • Delano, CA
  • NPI 1447288345
  Medicare reassignment NPD
• Altamont Emergency Physicians Medical Group Inc

  • Emergency Medicine Physician
  • Tracy, CA
  • NPI 1952392375
  Medicare reassignment
• Fairfield Memorial Hospital Association

  • Critical Access Hospital
  • Fairfield, IL
  • NPI 1255422416
  NPD
• Fairfield Memorial Hospital Association

  dba Horizon Healthcare

  • Rural Health Clinic/Center
  • Fairfield, IL
  • NPI 1295908853
  NPD
• South Lyon Health Center, Inc.

  dba South Lyon Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Yerington, NV
  • NPI 1285008219
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Fairfield Memorial Hospital Association

  • Critical Access Hospital
  • Fairfield, IL
  • NPI 1255422416
  Care Compare affiliation
• Mark Twain Medical Center

  • Critical Access Hospital
  • San Andreas, CA
  • NPI 1508968819
  Care Compare affiliation
• Northern Inyo Healthcare District

  dba Northern Inyo Hospital

  • Critical Access Hospital
  • Bishop, CA
  • NPI 1922198712
  Care Compare affiliation
• Southern Inyo Healthcare District

  • Critical Access Hospital
  • Lone Pine, CA
  • NPI 1831128602
  Care Compare affiliation

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229644800000",
    "number": "1972583185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 BROADWAY ST",
            "city": "ROCKPORT",
            "state": "TX",
            "postal_code": "783823333",
            "telephone_number": "361-729-0646",
            "fax_number": "361-729-8854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 BROADWAY ST",
            "city": "ROCKPORT",
            "state": "TX",
            "postal_code": "783823333",
            "telephone_number": "361-729-0646",
            "fax_number": "361-729-8854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "JASIRI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2008-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "L4016",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A81294",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-098701",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L4016",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A812940",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036098701",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "3932056",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Irvin Corre Psychiatric Services PLLC
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• John J Hopper MD PLLC
• Katharine E. McNamara, PLLC (Katharine McNamara)
• Laura Margaret Kieschnick, PHARMD
• Karl Kietzke, M.D.
• Deedee Marie Kilough
• Kimberly Maroney, M.D., P.a.
• Klare Physical Therapy, PC

• Emergency Medicine Physician in Rockport, TX
• Providers in Rockport, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2008; 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.