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DR. KELLY SUE KENNEDY D.D.S.
NPI 1568673366
Oral & Maxillofacial Surgery in Columbus, OH

Active since May 24, 2007PECOS Enrolled
305 W 12TH AVE, DENTAL FACULTY PRACTICE, COLUMBUS, OH 43210(614) 292-5574(614) 292-9472 Get Directions Write a Review

NPPES record last updated: December 19, 2019. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Dr. Kelly Sue Kennedy D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KELLY SUE KENNEDY D.D.S. (NPI 1568673366) is an individual oral & maxillofacial surgery provider in Columbus, Ohio, licensed in Ohio (30.022717) and active in the NPI registry since May 2007. She is enrolled in Medicare PECOS, is affiliated with Ohio State University State Health System, and maintains a secondary practice location in Columbus.

NPPES Registry Identity

NPI1568673366
Entity TypeIndividualFemale
Primary Taxonomy204E00000X
Provider Legal NameDR. KELLY SUE KENNEDYCredential: D.D.S.
Location Address305 W 12TH AVE, DENTAL FACULTY PRACTICEColumbus, OH 43210-1267
Mailing Address305 W 12th AveColumbus, OH 43210-1267 · (614) 292-5574 · Fax (614) 292-9472
Phone(614) 292-5574
Fax(614) 292-9472
Sole ProprietorYes
Medical School CMSOtherGraduated 2008
Enumeration DateMay 24, 2007
Last NPPES UpdateDecember 19, 2019
✔ NPI 1568673366 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyOral & Maxillofacial SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code204E00000X
License✔ Licensed in OH · 30.022717
Definition
Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery.
Also ListedDentist · Oral and Maxillofacial SurgeryTaxonomy 1223S0112X · License 2322 (OH), 30-022717 (OH)
305 W 12TH AVE, Columbus, OH 43210
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Other Names 1

Former Name (1)Dr. Kelly Sue Kreuter D.d.s.

Secondary Practice Location 1

Location 1700 Childrens DrColumbus, OH 43205-2639 · Phone (614) 722-5651 · Fax (614) 355-4497

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Antidote Health Plan of Ohio, Inc., Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kelly Sue Kennedy D.d.s. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7911062955
PECOS Enrollment IDI20090209000081
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kelly Kennedy reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Ohio State Dental Faculty Practice Inc
Same address
Dentist
305 W. 12TH AVENUE, 4TH FLOOR POSTLE HALL
Columbus, OH 43210
  • Reassigned Medicare billing, Ohio enrollment
  • 11 clinicians in this Medicare group
NPI 1164537684 (614) 292-1472

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Ohio State University State Health System

Acute Care Hospitals · Columbus, OH
4/5 CMS rating
OwnershipGovernment - State
CMS Certification Number360085
Location410 West 10th AvenueColumbus, OH 43210 · Franklin County
Emergency services Birthing friendly

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. TIMOTHY GARTH WEAVER D.D.S.
Dentist
305 W 12TH AVE
COLUMBUS, OH 43210
Franklin County (614) 292-7473
MITCHELL THAI
Dentist (General Practice)
305 W 12TH AVE
COLUMBUS, OH 43210
Franklin County (614) 292-4468
DIANA MAHMOODI DMD
Dentist (Prosthodontics)
305 W 12TH AVE
COLUMBUS, OH 43210
Franklin County (703) 608-6431
DR. ELMER JAY NEWNESS D.D.S.
Dentist
305 W 12TH AVE
COLUMBUS, OH 43210
Franklin County (614) 292-3015
DANIEL STENTZ D.D.S.
Dentist
305 W 12TH AVE, ROOM 3059C POSTLE HALL
COLUMBUS, OH 43210
Franklin County (614) 292-3596
JENNIFER BURZYNSKI DMD
Dentist (Orthodontics and Dentofacial Orthopedics)
305 W 12TH AVE, OSU DEPARTMENT OF ORTHODONTICS
COLUMBUS, OH 43210
Franklin County (614) 292-9100
DR. SOORYA SRINIVASAN D.M.D
Dentist (Orthodontics and Dentofacial Orthopedics)
305 W 12TH AVE
COLUMBUS, OH 43210
Franklin County (614) 688-4047
DR. BRYCE WOOLSEY DDS
Dentist
305 W 12TH AVE
COLUMBUS, OH 43210
Franklin County (614) 292-2622

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Kennedy's NPI number?

The NPI number for Kelly Kennedy is 1568673366. It was assigned to this individual provider in the NPPES registry on May 24, 2007. The provider is also known as Dr. Kelly Sue Kreuter D.D.S..

Where is Kelly Kennedy located?

Kelly Kennedy practices at 305 W 12th Ave Dental Faculty Practice, Columbus, OH 43210. The listed phone number is (614) 292-5574.

What is Kelly Kennedy's specialty?

The primary specialty registered for this NPI is Oral & Maxillofacial Surgery with taxonomy code 204E00000X.

Is Kelly Kennedy enrolled in Medicare?

Yes. Kelly Kennedy is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kelly Kennedy's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Kennedy reassigns Medicare benefits to Ohio State Dental Faculty Practice Inc (Columbus, OH). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelly Kennedy's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kelly Kennedy accept?

Health plans from Antidote Health Plan of Ohio, Inc., Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Delta Dental of Ohio and 1 other insurer list Kelly Kennedy as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Kelly Kennedy affiliated with any hospitals?

According to CMS data, Kelly Kennedy is affiliated with Ohio State University State Health System.

When was this NPI record last updated?

The NPPES record for Kelly Kennedy was last updated on December 19, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.