Kenilworth Primary Care LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

KENILWORTH PRIMARY CARE LLC

Practice address

66 S 21St St
Kenilworth, NJ 07033-1626

Phone

(908) 276-9595

Fax

(908) 276-6807

NPI assigned

Jan 24, 2012

Last updated

Jan 24, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Bhavani Jeereddy, M.D.NPI 1689833485

Title

Sole Member

Phone

(908) 276-9595

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

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.

• Bhavani Jeereddy, MD

  • Internal Medicine Physician
  • Kenilworth, NJ
  • NPI 1689833485
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1327363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327363200000",
    "number": "1164793014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 S 21ST ST",
            "city": "KENILWORTH",
            "state": "NJ",
            "postal_code": "070331626",
            "telephone_number": "908-276-9595",
            "fax_number": "908-276-6807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 S 21ST ST",
            "city": "KENILWORTH",
            "state": "NJ",
            "postal_code": "070331626",
            "telephone_number": "908-276-9595",
            "fax_number": "908-276-6807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENILWORTH PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-24",
        "last_updated": "2012-01-24",
        "status": "A",
        "authorized_official_last_name": "JEEREDDY",
        "authorized_official_first_name": "BHAVANI",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "908-276-9595",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Kane
• Sean L. Kaufman, D.P.M
• Ahmad Kazemi, MD
• Courtney Keating, LAT, ATC
• Kenilworth Dental Associates, LLC
• Kenilworth School District
• Tony Pierre Kerbaj, DPM
• Kero Transportation Inc.,
• Karen Kiefer, APN
• David Mark Klugman, D.M.D.

• Primary Care Clinic/Center in Kenilworth, NJ
• Providers in Kenilworth, NJ by specialty
• Primary Care Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.