Mark E Kennedy

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

Practice address

2200 State St
Lawrenceville, IL 62439-1852

Phone

(618) 943-1000

NPI assigned

Jun 14, 2007

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Lawrence County Memorial Hospital

  • Critical Access Hospital
  • Lawrenceville, IL
  • NPI 1386744795
  NPD (past)
• Southern Illinois Anesthesia LTD

  • Anesthesiology Physician
  • Princeton, IN
  • NPI 1932145000
  NPD (past)

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972707792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 STATE ST",
            "city": "LAWRENCEVILLE",
            "state": "IL",
            "postal_code": "624391852",
            "telephone_number": "618-943-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 STATE ST",
            "city": "LAWRENCEVILLE",
            "state": "IL",
            "postal_code": "624391852",
            "telephone_number": "618-943-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "MARK",
        "middle_name": "E",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATION",
            "identifier": "038221",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mikah Jenkins
• Matthew Jones
• Alexandria Paige Kauble
• Jamie Keepes, COTA/L
• Sloane M Kelly
• Logan Kermicle, LPN
• Samantha Kiser
• Heather Klein, LMT
• Cassandra Kohlhause
• Mitzi R Kurtz

• Certified Registered Nurse Anesthetist in Lawrenceville, IL
• Providers in Lawrenceville, IL by specialty
• Certified Registered Nurse Anesthetist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.