DR. TRACY MARTIG KENNETZ (NPI# 1790774362) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790774362 |
| Entity Type | Individual |
| Full Name | DR. TRACY MARTIG KENNETZ |
| Credential | M.D. |
| Practice Address |
1423 N National Ave Springfield MO 65802-2047 |
| Mailing Address |
1304 E Republic Rd Springfield MO 65804-7210 |
| Practice Telephone | 4172696583 |
| Practice Fax Number | 4172696573 |
| Mailing Telephone | 4172696583 |
| Mailing Fax Number | 4172696573 |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2018-10-01 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | E-11413 | AR | Allopathic & Osteopathic Physicians |
| N | 207P00000X | Emergency Medicine | 2001004533 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 205227101 | 05 |
| Street Address |
1423 N NATIONAL AVE |
| City | SPRINGFIELD |
| State | MO |
| Zip Code | 65802-2047 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235117086 | Edward Skeins Jr. | Emergency Medicine | 1423 N National Ave, Springfield, MO 65802-2047 | 2006-01-03 |
| 1144208992 | Richard Swinney | Emergency Medicine | 1423 N National Ave, Springfield, MO 65802-2047 | 2006-01-03 |
| 1982680724 | Walter Simpson | Emergency Medicine | 1423 N National Ave, Springfield, MO 65802-2047 | 2005-12-22 |
| 1144207986 | William Steinmetz | Emergency Medicine | 1423 N National Ave, Springfield, MO 65802-2047 | 2005-12-22 |
| 1801870324 | Jock Porter | Emergency Medicine | 1423 N National Ave, Springfield, MO 65802-2047 | 2005-11-30 |
| 1144204611 | Camala Porter | Emergency Medicine | 1423 N National Ave, Springfield, MO 65802-2047 | 2005-11-30 |
| 1881678365 | Mark Ross | Emergency Medicine | 1423 N National Ave, Springfield, MO 65802-2047 | 2005-11-30 |
| 1467433300 | Dennis Kenyon | Emergency Medicine | 1423 N National Ave, Springfield, MO 65802-2047 | 2005-11-08 |
| 1376524215 | Bradley Messner | Emergency Medicine | 1423 N National Ave, Springfield, MO 65802-2047 | 2005-11-08 |
| 1841271723 | David Lee | Emergency Medicine | 1423 N National Ave, Springfield, MO 65802-2047 | 2005-11-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407454549 | Andrea Strauch | Counselor | 2024 W Chestnut Expressway Way, Springfield, MO 65802 | 2020-10-12 |
| 1962968867 | Chad Michael Linck | Specialist/Technologist | 2125 N Glenstone Ave, Springfield, MO 65802 | 2019-02-15 |
| 1790254647 | Meds To Live By | Pharmacist | 1134 N. Scarlett Way, Springfield, MO 65802 | 2018-11-21 |
| 1568945103 | Ficom | Non-Pharmacy Dispensing Site | 1308 North Glenstone Avenue, Springfield, MO 65802 | 2018-09-10 |
| 1982194775 | Karla Caballero | Marriage & Family Therapist | 8627 Montant Fort Way, 145, Sprinfield, MO 65802 | 2018-05-16 |
| 1780191809 | Tiffany Chawntay Coryell | Pharmacist | 1134 North Scarlett Way, Springfield, MO 65802 | 2018-01-10 |
| 1083134902 | Trevor Conner | Family Medicine | 1423 N Jefferson Ave, B100, Springfield, MO 65802 | 2017-06-21 |
| 1407389596 | Medical Mile Imaging | Radiology | 3905 E Windsmore Dr, Springfield, MO 65802 | 2017-04-06 |
| 1346619103 | Jill A Knight | Occupational Therapist | 1601 E. Pythian, Green Valley State School, Springfield, MO 65802 | 2015-09-22 |
| 1447653258 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 3720 E Sunshine St, Springfield, MO 65802 | 2014-10-07 |
| Find all providers in zip 65802 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225650773 | Evan Alexander Jenkins | Emergency Medicine | 701 N 1st St Ste 220, Springfield, IL 62702-3757 | 2020-05-07 |
| 1518523810 | Center for Vein Restoration Ma LLC | Emergency Medicine | 3640 Main St Ste 302, Springfield, MA 01107-1134 | 2019-05-13 |
| 1477081453 | Breeanna Murphy | Emergency Medicine | 701 N 1st St Ste D220, Springfield, IL 62702-3757 | 2017-06-02 |
| 1851822431 | Sean Murray | Emergency Medicine | 2121 S 4th St, Springfield, IL 62703-3449 | 2017-03-24 |
| 1285093393 | Medexpress Urgent Care, PC - Massachusetts | Emergency Medicine | 1312 Boston Road, Springfield, MA 01119-1336 | 2016-02-17 |
| 1306220488 | Andrea Marie-gioia Spangler | Emergency Medicine | 1235 E Cherokee St Dept Of, Springfield, MO 65804-2203 | 2015-07-17 |
| 1134506488 | Medexpress Urgent Care, PC - Massachusetts | Emergency Medicine | 430 Cooley St, Springfield, MA 01128-1180 | 2015-05-06 |
| 1669805016 | Medexpress Urgent Care - Northern New Jersey, PC | Emergency Medicine | 200 Us Highway 22, Springfield, NJ 07081-3123 | 2013-08-20 |
| 1346582046 | Shannon Macritchie | Emergency Medicine | 3333 Riverbend Dr., Springfield, OR 97401 | 2013-03-20 |
| 1902156839 | Lindsey Michelle Krawczuk | Emergency Medicine | 3801 S. National Ave., Springfield, MO 65807 | 2012-09-18 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 65802 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.