NPIMap

Individual provider Active NPI

Jose A. Camacho, MD

  • Internal Medicine Physician
  • Woodbury, NJ
National Provider Identifier
1073612008
Registry record updated Mar 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MA05594500 Issued in NJ
Practice address
190 N Evergreen Ave Ste 102
Woodbury, NJ 08096-1862
Phone
(844) 542-2273
Fax
(856) 845-9698
NPI assigned
Sep 22, 2006
Last updated
Mar 2, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2018

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 MA05594500 NJ Primary

Addresses

Primary practice location

190 N Evergreen Ave Ste 102
Woodbury, NJ 08096-1862

Mailing address

190 N Evergreen Ave
Suite 102
Woodbury, NJ 08096-1862
Phone (844) 542-2273

Other practice location 1

190 N Evergreen Ave Ste 102
Woodbury, NJ 08096-1862
Phone (844) 542-2273

Other identifiers 1

IdentifierTypeStateIssuer
4604806MedicaidNJ

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
I20050708000422 NJ Practitioner - Internal Medicine 4284671975 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Temple University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

159 S Broad St
Kha Woodbury
Woodbury, NJ 08096-2410
Phone (844) 542-2273

457 Haddonfield Rd
Suite 110
Cherry Hill, NJ 08002-2223
Phone (844) 542-2273

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA05594500NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy Medical Group Practice P.C. CurrentSince Feb 1, 2018 Accepting new patients
Kennedy Medical Group Practice, P.C. Internal Medicine CurrentSince Jun 15, 2021 Accepting new patients
Kennedy Medical Group Practice PC CurrentSince Feb 1, 2018 Accepting new patients
Kennedy Medical Group Practice P.C. Past Accepting new patients
Laskin & Higgins Internal Medicine LLC Internal Medicine PastSince Apr 30, 2003 Accepting new patients

Locations

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

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

400 Laurel Oak Rd
Ste 105
Voorhees, NJ 08043
Phone (609) 304-0991

190 N Evergreen Ave
Ste 102
Woodbury, NJ 08096
Phone (856) 546-3003

Ownership & related parties

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Southern Jersey Family Medical Centers, IncPleasantville, NJ, CCN 311813 Federally qualified health center Corporate Director May 21, 1998
Southern Jersey Family Medical Centers, IncSalem, NJ, CCN 311828 Federally qualified health center Corporate Director May 21, 1998
Southern Jersey Family Medical Centers, IncNew Lisbon, NJ, CCN 311859 Federally qualified health center Corporate Director Mar 16, 2007
Southern Jersey Family Medical Centers, IncHammonton, NJ, CCN 311804 Federally qualified health center Corporate Director Mar 16, 2007
Southern Jersey Family Medical Centers, IncAtlantic City, NJ, CCN 311835 Federally qualified health center Corporate Director May 21, 1998
Southern Jersey Family Medical Centers, IncBurlington City, NJ, CCN 311875 Federally qualified health center Corporate Director Feb 5, 2007
Southern Jersey Family Medical Centers, IncAtlantic City, NJ, CCN 311883 Federally qualified health center Corporate Director May 21, 1998
Southern Jersey Family Medical Centers, IncEgg Harbor Township, NJ, CCN 311937 Federally qualified health center Corporate Director Mar 16, 2007

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519948800000",
    "number": "1073612008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 N EVERGREEN AVE",
            "address_2": "SUITE 102",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080961862",
            "telephone_number": "844-542-2273",
            "fax_number": "856-845-9398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 N EVERGREEN AVE STE 102",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080961862",
            "telephone_number": "844-542-2273",
            "fax_number": "856-845-9698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "190 N Evergreen Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Woodbury",
            "state": "NJ",
            "postal_code": "080961862",
            "country_code": "US",
            "telephone_number": "844-542-2273",
            "fax_number": "856-845-9698",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMACHO",
        "first_name": "JOSE",
        "middle_name": "A.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2018-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MA05594500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4604806",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, NJ

Sources for this page

Verify at the official NPI Registry.