NPIMap

Organization Active NPI

Kennedy Medical Group Practice, P.C.

Doing business as Kennedy Health Alliance

  • Vascular Surgery Physician
  • Voorhees, NJ
National Provider Identifier
1073884847
Registry record updated Oct 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
25MA09025500 Issued in NJ
Legal business name
KENNEDY MEDICAL GROUP PRACTICE, P.C.
Doing business as
Kennedy Health Alliance
Practice address
333 Laurel Oak Rd
Voorhees, NJ 08043-4453
Phone
(856) 783-0191
Fax
(856) 783-0264
NPI assigned
Jan 25, 2012
Last updated
Oct 13, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
KENNEDY MEMORIAL HOSPITAL UNIVERSITY MEDICAL CENTER INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 13, 2015

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

Authorized official

Name
Kathy Schleider
Title
VP Clinical Integration
Phone
(856) 344-7360

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0129X 25MA09025500 NJ Primary

Addresses

Primary practice location

333 Laurel Oak Rd
Voorhees, NJ 08043-4453

Mailing address

333 Laurel Oak Rd
Voorhees, NJ 08043-4453
Phone (856) 783-0191

Other names 1

  • Kennedy Health Alliance Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140613000689 NJ Part B Supplier - Clinic/Group Practice 2860616877 Receives reassigned benefits from 487 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sewell, NJ; Stratford, NJ; Turnersville, NJ; Voorhees, NJ; West Berlin, NJ; West Deptford, NJ; Woodbury, NJ; Marlton, NJ…

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Part of
Mark a Demasi DO

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1327449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444694400000",
    "number": "1073884847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 LAUREL OAK RD",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080434453",
            "telephone_number": "856-783-0191",
            "fax_number": "856-783-0264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 LAUREL OAK RD",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080434453",
            "telephone_number": "856-783-0191",
            "fax_number": "856-783-0264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY MEDICAL GROUP PRACTICE, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENNEDY MEMORIAL HOSPITAL UNIVERSITY MEDICAL CENTER INC.",
        "enumeration_date": "2012-01-25",
        "last_updated": "2015-10-13",
        "status": "A",
        "authorized_official_last_name": "SCHLEIDER",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "VP CLINICAL INTEGRATION",
        "authorized_official_telephone_number": "856-344-7360"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "NJ",
            "license": "25MA09025500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kennedy Health Alliance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Voorhees, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.