Individual provider Active NPI

Michelle Ashley Kiedaisch, AU.D.

  • Audiologist
  • Philadelphia, PA
National Provider Identifier
1285339671
Registry record updated Mar 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Practice address
925 Chestnut St FL 6
Philadelphia, PA 19107-4204
Phone
(800) 533-3669
NPI assigned
Apr 4, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X Primary

Addresses

Primary practice location

925 Chestnut St FL 6
Philadelphia, PA 19107-4204

Mailing address

1900 Frontage Rd Apt 1711
Cherry Hill, NJ 08034-2217

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230718003223 NJ Practitioner - Qualified Audiologist 2860852142 Reassigns benefits to 2 organizations
I20250319001550 PA Practitioner - Qualified Audiologist 2860852142 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University Physicians of New Jersey PCGroup PAC ID 9931325131, 117 clinicians
Kennedy Medical Group Practice, P.C.Group PAC ID 2860616877, 417 clinicians

Practice addresses (Care Compare)

2211 Chapel Ave W
Suite 403
Cherry Hill, NJ 08002-2048
Phone (856) 922-5030

354 Hurffville Crosskeys Rd
BLDG 2
Sewell, NJ 08080-3550
Phone (844) 542-2273

Merit-based Incentive Payment System (MIPS)

Final score
90.54 of 100Reported as group
Quality
89.88
Promoting interoperability
87
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy Medical Group Practice PC CurrentSince Jun 1, 2025 Accepting new patients
Jefferson University Physicians CurrentSince Mar 3, 2025 Accepting new patients
Kennedy Medical Group P.C. CurrentSince Jun 1, 2025 Accepting new patients
Kennedy Medical Group Practice, P.C. Current Accepting new patients
Jefferson University Physicians of New Jersey, P.C. CurrentSince Mar 3, 2025 Accepting new patients

Locations

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

2211 Chapel Ave W
Ste 403
Cherry Hill, NJ 08002
Phone (856) 922-5030

354 Hurffville Crosskeys Rd
Bldg 2
Sewell, NJ 08080
Phone (856) 566-3190

443 Laurel Oak Rd
Ste 130
Voorhees, NJ 08043
Phone (856) 741-0122

1101 Market St
Fl 19
Philadelphia, PA 19107
Phone (215) 481-6836

1101 Chestnut St
Philadelphia, PA 19107
Phone (215) 955-6760

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

Interoperability endpoints

  • Direct secure messaging: mkiedaisch@advancedent.emadirect.md

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1680566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741651200000",
    "number": "1285339671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 FRONTAGE RD APT 1711",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080342217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 CHESTNUT ST FL 6",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074204",
            "telephone_number": "800-533-3669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIEDAISCH",
        "first_name": "MICHELLE",
        "middle_name": "ASHLEY",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-04",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2025; 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.