Ethan Owen Kennedy, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

3123 Issued in AZ

Practice address

10240 W Indian School Rd Ste 155
Phoenix, AZ 85037-5909

Phone

(623) 385-7900

Fax

(623) 440-4360

NPI assigned

Nov 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Family Practice

Education

Kansas City University of Med & Biosciences, College of Osteo Med, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Healthy Life CorporationGroup PAC ID 9739353061, 10 clinicians

Ceb Capital LLCGroup PAC ID 0244537561, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Josephs Hospital and Medical Center Hospital, Phoenix, AZ, CCN 030024

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: ethan.kennedy@direct.digidms.com

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.

• Ceb Capital LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1750754982
  Medicare reassignment Care Compare group NPD
• Healthy Life Corporation

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1548510365
  Medicare reassignment Care Compare group NPD
• Ceb Capital LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1073986212
  NPD
• Avondale Urgent Care LLC

  • Urgent Care Clinic/Center
  • Avondale, AZ
  • NPI 1134185671
  NPD (past)
• Chandler Urgent Care LLC

  • Urgent Care Clinic/Center
  • Chandler, AZ
  • NPI 1881650471
  NPD (past)
• Dana Landing Urgent Care LLC

  • Urgent Care Clinic/Center
  • Mesa, AZ
  • NPI 1770549214
  NPD (past)
• Desert Ridge Urgent Care LLC

  • Urgent Care Clinic/Center
  • Phoenix, AZ
  • NPI 1861458309
  NPD (past)
• Effideen Ameerally MD PC

  • Family Medicine Physician
  • Mesa, AZ
  • NPI 1891740296
  NPD (past)
• Glendale Urgent Care LLC

  • Urgent Care Clinic/Center
  • Glendale, AZ
  • NPI 1043276587
  NPD (past)
• Greenway Urgent Care LLC

  • Urgent Care Clinic/Center
  • Phoenix, AZ
  • NPI 1629034210
  NPD (past)
• Nextcare Arizona I JV LLC

  • Urgent Care Clinic/Center
  • Tempe, AZ
  • NPI 1114798071
  NPD (past)
• Nextcare Arizona LLC

  • Urgent Care Clinic/Center
  • Tempe, AZ
  • NPI 1043371826
  NPD (past)

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

• Dignity Health

  • Emergency Care Clinic/Center
  • Litchfield Park, AZ
  • NPI 1265065445

  Hospital

  Care Compare affiliation
• Dignity Health

  • Emergency Care Clinic/Center
  • Glendale, AZ
  • NPI 1609408665

  Hospital

  Care Compare affiliation
• Dignity Health

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1982733655
  Care Compare affiliation
• Dignity Health

  • General Acute Care Hospital
  • Glendale, AZ
  • NPI 1992131734
  Care Compare affiliation

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1972679181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10240 W INDIAN SCHOOL RD STE 155",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375909",
            "telephone_number": "623-385-7900",
            "fax_number": "623-440-4360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10240 W INDIAN SCHOOL RD STE 155",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375909",
            "telephone_number": "623-385-7900",
            "fax_number": "623-440-4360"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8260 W Indian School Rd Ste 4",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850332980",
            "country_code": "US",
            "telephone_number": "623-247-2300",
            "fax_number": "623-247-2300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "ETHAN",
        "middle_name": "OWEN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "3123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "452673",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kennedy Allure LLC
• Angela Kennedy, PT
• Cailyn Kennedy
• Charles A Kennedy, LCSW
• Darren J Kennedy, RPH
• Hannah Kennedy, LAC
• Jane Kennedy, MT
• Jean Kennedy, R.N.
• Karen Leslie Kennedy, M.D.
• Katherine Edithe Kennedy, DPM

• Family Medicine Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; 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.