NPIMap

Organization Active NPI

Kennedy Medical Group Practice, P.C.D/B/a Kennedy Health Alliance

  • Internal Medicine Physician
  • Turnersville, NJ
National Provider Identifier
1154347367
Registry record updated Mar 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
KENNEDY MEDICAL GROUP PRACTICE, P.C.D/B/A KENNEDY HEALTH ALLIANCE
Practice address
151 Fries Mill Rd
Suite 400
Turnersville, NJ 08012
Phone
(856) 401-9300
Fax
(856) 374-5805
NPI assigned
Jul 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2015

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

Authorized official

Name
Debbie O'Neil
Title
Credentialing
Phone
(856) 783-1987

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

151 Fries Mill Rd
Suite 400
Turnersville, NJ 08012

Mailing address

151 Fries Mill Rd
Suite 400
Turnersville, NJ 08012
Phone (856) 401-9300

Other identifiers 1

IdentifierTypeStateIssuer
7650001MedicaidNJ

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

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427414400000",
    "number": "1154347367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 FRIES MILL RD",
            "address_2": "SUITE 400",
            "city": "TURNERSVILLE",
            "state": "NJ",
            "postal_code": "08012",
            "telephone_number": "856-401-9300",
            "fax_number": "856-374-5805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 FRIES MILL RD",
            "address_2": "SUITE 400",
            "city": "TURNERSVILLE",
            "state": "NJ",
            "postal_code": "08012",
            "telephone_number": "856-401-9300",
            "fax_number": "856-374-5805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY MEDICAL GROUP PRACTICE, P.C.D/B/A KENNEDY HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2015-03-27",
        "status": "A",
        "authorized_official_last_name": "O'NEIL",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "856-783-1987"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7650001",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Turnersville, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 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.