Individual provider Active NPI

Courtney Elizabeth Hennelly, APN

  • Family Nurse Practitioner
  • Basking Ridge, NJ
National Provider Identifier
1265623763
Registry record updated Mar 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
33 334424 Issued in NY
Practice address
136 Mountainview Blvd
Basking Ridge, NJ 07920-3444
Phone
(908) 542-3500
Fax
(908) 542-3211
NPI assigned
Aug 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 26NJ00345800 NJ
Family Nurse Practitioner 363LF0000X 33 334424 NY Primary

Addresses

Primary practice location

136 Mountainview Blvd
Basking Ridge, NJ 07920-3444

Mailing address

136 Mountainview Blvd
Basking Ridge, NJ 07920-3444
Phone (908) 542-3500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080807000264 NY Practitioner - Nurse Practitioner 5193899268 Reassigns benefits to 1 organization
I20130109000140 NJ Practitioner - Nurse Practitioner 5193899268 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

136 Mountain View Blvd
Basking Ridge, NJ 07920-3444

136 Mountainview Blvd
Basking Ridge, NJ 07920-3444
Phone (908) 542-3000

Hospital & facility affiliations

  • Memorial Hospital for Cancer and Allied Diseases Hospital, New York, NY, CCN 330154

Merit-based Incentive Payment System (MIPS)

Final score
81.57 of 100Reported as group
Quality
72.31
Improvement activities
40
Cost
76.55

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ00345800NJMDFamily Nurse Practitioner
33 334424NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Pediatric Group CurrentSince Nov 9, 2017 Accepting new patients
Memorial Sloan Kettering Cancer Center at Basking Ridge New Jersey CurrentSince Nov 8, 2012 Accepting new patients

Locations

136 Mountainview Blvd
Basking Ridge, NJ 07920
Phone (908) 542-3000

480 Red Hill Rd
Middletown, NJ 07748
Phone (908) 542-3007

633 3rd Ave
Lbby 3
New York, NY 10017
Phone (848) 225-6000

1275 York Ave
New York, NY 10065
Phone (212) 639-3813

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: chennelly39189@mskcc.direct-ci.com

Organizations & group practices 2

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

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1186531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332288000000",
    "number": "1265623763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 MOUNTAINVIEW BLVD",
            "city": "BASKING RIDGE",
            "state": "NJ",
            "postal_code": "079203444",
            "telephone_number": "908-542-3500",
            "fax_number": "908-542-3211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 MOUNTAINVIEW BLVD",
            "city": "BASKING RIDGE",
            "state": "NJ",
            "postal_code": "079203444",
            "telephone_number": "908-542-3500",
            "fax_number": "908-542-3211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNELLY",
        "first_name": "COURTNEY",
        "middle_name": "ELIZABETH",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-08",
        "last_updated": "2012-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00345800",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "33 334424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Basking Ridge, NJ

Sources for this page

Verify at the official NPI Registry.