Damon Mark Kennedy, DO

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

E-18514 Issued in AR

Practice address

4802 E Johnson Ave
Jonesboro, AR 72405-8413

Phone

(870) 936-8000

Fax

(870) 934-3628

NPI assigned

Jun 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 7

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CO, WY, AR3 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

Thoracic SurgeryAlso: Cardiac Surgery

Education

University of North Texas HSC, College of Osteopathic Med, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeast Arkansas Clinic Charitable Foundation, Inc.Group PAC ID 2961547526, 294 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Memorial Hospital Jonesboro, Inc. Hospital, Jonesboro, AR, CCN 040118

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Northeast Arkansas Clinic Charitable Foundation, Inc.

  • Multi-Specialty Clinic/Center
  • Jonesboro, AR
  • NPI 1861721839
  Medicare reassignment Care Compare group NPD
• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1225356868

  Surgery

  Medicare reassignment NPD
• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1366763260

  Thoracic Surgery (Cardiothoracic Vascular Surgery), WY

  Medicare reassignment NPD
• Northeast Arkansas Clinic Charitable Foundation, Inc.

  • Mobile Mammography Clinic/Center
  • Jonesboro, AR
  • NPI 1417721689
  NPD
• Northeast Arkansas Clinic Charitable Foundation, Inc.

  • Clinical Medical Laboratory
  • Jonesboro, AR
  • NPI 1801127030
  NPD
• Northeast Arkansas Clinic Charitable Foundation, Inc.

  • Anesthesiology Physician
  • Jonesboro, AR
  • NPI 1992036032
  NPD (past)
• Glen Rose Medical Foundation

  • Certified Registered Nurse Anesthetist
  • Glen Rose, TX
  • NPI 1992749857
  NPD (past)

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

• Baptist Memorial Hospital-Jonesboro Inc

  • General Acute Care Hospital
  • Jonesboro, AR
  • NPI 1386699353
  Care Compare affiliation

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1992733224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1960",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724031960",
            "telephone_number": "870-936-8000",
            "fax_number": "870-934-3628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 E JOHNSON AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724058413",
            "telephone_number": "870-936-8000",
            "fax_number": "870-934-3628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "DAMON",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "CO",
            "license": "47892",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CO",
            "license": "DR.0047892",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "CO",
            "license": "47892",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CO",
            "license": "DR.0047892",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "WY",
            "license": "10460A",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "TX",
            "license": "L2368",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "AR",
            "license": "E-18514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "68856750",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025839700",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madi Kelso, PLMSW
• Charles E Kemp, M.D.
• Joanne Kemp
• Ken Wood, D.D.S. M.S. Childrens Dentistry
• Constance Kennedy
• Jayme Kennedy
• Kinley Kennedy
• Lyle Kennedy, RN
• Melody Lynn Kent, APRN
• Lisa Karen Kenyon, PT

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; 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.