Dr Kelly Sue Kennedy, DDS is a medicare enrolled "Oral & Maxillofacial Surgery" provider in Columbus, Ohio. She graduated from medical school in 2008 and has 16 years of diverse experience with area of expertise as Maxillofacial Surgery. She is a member of the group practice Ohio State Dental Faculty Practice Inc and her current practice location is
305 W 12th Ave, Dental Faculty Practice, Columbus, Ohio. You can reach out to her office (for appointments etc.) via phone at
(614) 292-5574.
Dr Kelly Sue Kennedy is licensed to practice in Ohio (license number 30.022717) and she also participates in the medicare program. She
may accept medicare assignments (which means she may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and her NPI Number is 1568673366.
Healthcare Provider's Profile
| Full Name | Dr Kelly Sue Kennedy |
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| Gender | Female |
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| Speciality | Maxillofacial Surgery |
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| Experience | 16 Years |
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| Location | 305 W 12th Ave, Columbus, Ohio |
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| Accepts Medicare Assignments | May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Kelly Sue Kennedy graduated from medical school in 2008
NPI Data:
- NPI Number: 1568673366
- Provider Enumeration Date: 05/24/2007
- Last Update Date: 12/19/2019
Medicare PECOS Information:
- PECOS PAC ID: 7911062955
- Enrollment ID: I20090209000081
Medical Identifiers
Medical identifiers for Dr Kelly Sue Kennedy such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1568673366 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 30-022717 (Ohio) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 2322 (Ohio) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | 30.022717 (Ohio) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Ohio State Dental Faculty Practice Inc | 5496788630 | 3 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Kelly Sue Kennedy allows following entities to bill medicare on her behalf.
| Entity Name | Ohio State Dental Faculty Practice Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1164537684
PECOS PAC ID: 5496788630
Enrollment ID: O20050916000944 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Kelly Sue Kennedy is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Kelly Sue Kennedy, DDS
305 W 12th Ave,
Columbus, OH 43210-1267
Ph: (614) 292-5574 | Dr Kelly Sue Kennedy, DDS
305 W 12th Ave, Dental Faculty Practice,
Columbus, OH 43210-1267
Ph: (614) 292-5574 |
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