Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kenneth Patrick O'Connor, PA-C

Individual provider Physician Assistant · NPI 1790433043

Kenneth Patrick O'Connor, PA-C is a Physician Assistant in Greenwood, Indiana. Qualified in 2022, 4 years ago. Practices with The South Bend Clinic LLC, a 170-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
4
Licensed in
IN
In the registry since
2022
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

555 E County Line Rd
Greenwood, IN 46143-1063
Phone: (317) 497-2130
Fax: (317) 957-2730
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 52500 Fir Rd, Granger, IN 46530-8579 — (574) 234-8161
  • 211 N Eddy St, South Bend, IN 46617-3096 — (574) 234-8161

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 10003872A (IN)
Physician Assistant Taxonomy 363A00000X · Licence 99114487A (IN)

Record details

NPI number1790433043
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMarch 15, 2022
Last updated in NPPESJuly 2, 2026
Certification dateJuly 2, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice The South Bend Clinic Llc — 170 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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