NPIMap

Organization Active NPI

Kennedy Medical Group Practice, P.C.

Doing business as Kennedy Health Alliance

  • Family Medicine Physician
  • Stratford, NJ
National Provider Identifier
1437410990
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KENNEDY MEDICAL GROUP PRACTICE, P.C.
Doing business as
Kennedy Health Alliance
Practice address
205 E Laurel Rd
2ND Floor
Stratford, NJ 08084-1301
Phone
(856) 816-0255
NPI assigned
May 31, 2012
Last updated
Nov 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

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

Authorized official

Name
Ricardo Perez
Title
Vice President of Clinical Operatio
Phone
(856) 218-5634

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X
Obstetrics & Gynecology Physician 207V00000X
Neurology Physician 2084N0400X
Surgery Physician 208600000X
Vascular Surgery Physician 2086S0129X

Addresses

Primary practice location

205 E Laurel Rd
2ND Floor
Stratford, NJ 08084-1301

Mailing address

400 Laurel Oak Rd Ste 105
Voorhees, NJ 08043-4455
Phone (856) 922-9894

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
Tax ID family
Kennedy Medical Group Practice PC Dba Kennedy Health Alliance36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

Locations

435 Hurffville Cross Keys Rd
Ste 192
Blackwood, NJ 08012

2201 Chapel Ave W
#301
Cherry Hill, NJ 08002

2201 Chapel Ave W
Ste 193
Cherry Hill, NJ 08002

2211 Chapel Ave W
Fl 3
Cherry Hill, NJ 08002

457 Haddonfield Rd
Ste 100
Cherry Hill, NJ 08002

80 Tanner St
#2
Haddonfield, NJ 08033

80 Tanner St
#3
Haddonfield, NJ 08033

693 Main St
Ste A
Lumberton, NJ 08048

354 Hurffville Crosskeys Rd
#B3
Sewell, NJ 08080

445 Hurffville Crosskeys Rd
Ste A
Sewell, NJ 08080
Phone (856) 557-5573

445 Hurffville Crosskeys Rd
Ste B12
Sewell, NJ 08080

565 Egg Harbor Rd
Ste C
Sewell, NJ 08080

900 Medical Center Dr
#2
Sewell, NJ 08080

900 Medical Center Dr
Ste 200
Sewell, NJ 08080
Phone (856) 557-7900

1200 S White Horse Pike
Ste 1
Somerdale, NJ 08083

18 E Laurel Rd
Ste 194
Stratford, NJ 08084

205 E Laurel Rd
Fl 2
Stratford, NJ 08084
Phone (856) 282-6511

151 Fries Mill Rd
Turnersville, NJ 08012
Phone (215) 945-8882

188 Fries Mill Rd
Ste 1
Turnersville, NJ 08012

2301 E Evesham Rd
Ste 406
Voorhees, NJ 08043
Phone (856) 772-9600

333 Laurel Oak Rd
Ste 323
Voorhees, NJ 08043

333 Laurel Oak Rd
Ste 806
Voorhees, NJ 08043

301 N Route 73
Ste 335
West Berlin, NJ 08091

840 Walnut St
Fl 14
Philadelphia, PA 19107
Phone (215) 928-3105

909 Walnut St
Fl 2909
Philadelphia, PA 19107

Practitioners & affiliated clinicians

Practitioners 92

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.

View all 92

NPI Registry JSON

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

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1437410990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 LAUREL OAK RD STE 105",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080434455",
            "telephone_number": "856-922-9894",
            "fax_number": "856-922-9890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 E LAUREL RD",
            "address_2": "2ND FLOOR",
            "city": "STRATFORD",
            "state": "NJ",
            "postal_code": "080841301",
            "telephone_number": "856-816-0255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY MEDICAL GROUP PRACTICE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-31",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_title_or_position": "VICE PRESIDENT OF CLINICAL OPERATIO",
        "authorized_official_telephone_number": "856-218-5634"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kennedy Health Alliance",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kennedy Health Alliance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stratford, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; 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.