NPIMap

Individual provider Active NPI

Lisa Carlene Dimedio, D.O.

  • Internal Medicine Physician
  • Sewell, NJ
National Provider Identifier
1013028844
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MB06370800 Issued in NJ
Practice address
354 Hurffville Crosskeys Rd BLDG 2
Sewell, NJ 08080-3552
Phone
(844) 542-2273
NPI assigned
Aug 31, 2006
Last updated
Mar 16, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MB06370800 NJ Primary

Addresses

Primary practice location

354 Hurffville Crosskeys Rd BLDG 2
Sewell, NJ 08080-3552

Mailing address

354 Hurffville Crosskeys Rd BLDG 2
Sewell, NJ 08080-3552
Phone (844) 542-2273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101217000257 NJ Practitioner - Internal Medicine 6608810981 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

354 Hurffville Crosskeys Rd
BLDG 2
Sewell, NJ 08080-3550
Phone (844) 542-2273

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy Medical Group Practice, P.C. Internal Medicine CurrentSince Mar 1, 2016 Accepting new patients
Kennedy Medical Group Practice PC CurrentSince Mar 1, 2016 Accepting new patients
Kennedy University Hospital Inc. Past Accepting new patients
Virtua - West Jersey Health System, Inc. Past Accepting new patients
Kennedy Medical Group Practice P.C. Past Accepting new patients

Locations

457 Haddonfield Rd
Ste 110
Cherry Hill, NJ 08002
Phone (856) 406-4091

354 Hurffville Crosskeys Rd
Bldg 2
Sewell, NJ 08080
Phone (856) 566-3190

1 Regulus Dr
#A
Turnersville, NJ 08012
Phone (609) 589-7770

151 Fries Mill Rd
Ste 301
Turnersville, NJ 08012
Phone (856) 374-1881

443 Laurel Oak Rd
Ste 100
Voorhees, NJ 08043
Phone (215) 955-5050

Networks

  • devoted network organization-8ee96498-f86e-45f6-9fc9-a0f06c1636f9
  • devoted network organization-2d523d8e-e8f9-454a-bcd3-333df65bdbe8
  • devoted network organization-9f3dfbd3-4aa6-4c92-8e71-9c4ed35ce037

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1013028844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "354 HURFFVILLE CROSSKEYS RD BLDG 2",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080803552",
            "telephone_number": "844-542-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 HURFFVILLE CROSSKEYS RD BLDG 2",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080803552",
            "telephone_number": "844-542-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIMEDIO",
        "first_name": "LISA",
        "middle_name": "CARLENE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MB06370800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sewell, NJ

Sources for this page

Verify at the official NPI Registry.