Physician Compare National (NPI:1871576223)

HEALTHCARE PROVIDER: RAYMOND JAMES KENNEDY III MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1871576223
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9234186750
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050406000423
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KENNEDY
	Individual professional last name
Provider First Name	RAYMOND
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Name Suffix Text	III
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	LOYOLA UNIVERSITY OF CHICAGO, STRITCH SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1995
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	COUNTY OF SCOTT
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	4587605225
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	7
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	200 4TH AVE W
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 300
	Group Practice or individual's line 2 address
City	SHAKOPEE
	Group Practice or individual's city
State	MN
	Group Practice or individual's state
Zip Code	553791220
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9524968481
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	240004
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HENNEPIN COUNTY MEDICAL CENTER 1
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	240207
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	FAIRVIEW RIDGES HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y