Active NPI
Robert M Kennedy, MD
- Pediatric Emergency Medicine (Pediatrics) Physician
- Saint Louis, MO
National Provider Identifier
1992723449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Emergency Medicine (Pediatrics) Physician
- License
- R6C40
- Practice address
- 1 Childrens PL
Div Ped Emergency Med
Saint Louis, MO 63110-1002 - Phone
- (314) 454-2341
- Fax
- (314) 454-4345
- NPI assigned
- Jul 17, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | R6C40 | MO | |
| Pediatric Emergency Medicine (Pediatrics) Physician | 2080P0204X | R6C40 | MO | Primary |
Addresses
Primary practice location
1 Childrens PL
Div Ped Emergency Med
Saint Louis, MO 63110-1002
Mailing address
1 Childrens PL
MSC 8515-87-1200
Saint Louis, MO 63110-1002
Phone (314) 454-2341
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 202316212 | Medicaid | MO |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Washington University |
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 |
|---|---|---|---|
| R6C40 | MO | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636934400000",
"number": "1992723449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CHILDRENS PL",
"address_2": "MSC 8515-87-1200",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101002",
"telephone_number": "314-454-2341",
"fax_number": "314-454-4345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 CHILDRENS PL",
"address_2": "DIV PED EMERGENCY MED",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101002",
"telephone_number": "314-454-2341",
"fax_number": "314-454-4345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "ROBERT",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2021-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MO",
"license": "R6C40",
"primary": false
},
{
"code": "2080P0204X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Emergency Medicine",
"state": "MO",
"license": "R6C40",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "202316212",
"state": "MO"
}
],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
"affiliation": "Y",
"affiliationName": "Washington University",
"address_1": "1 Childrens Pl",
"address_2": "Div Ped Emergency Med",
"city": "Saint Louis",
"state": "MO",
"country_code": "US",
"postal_code": "631101002",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.