NPIMap

Organization Active NPI

Kennedy Medical Group Practice P.C.

Doing business as Kennedy Health Alliance

  • Prescribing (Medical) Psychologist
  • Blackwood, NJ
National Provider Identifier
1497295109
Registry record updated Feb 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prescribing (Medical) PsychologistTaxonomy code 103TP0016X
Legal business name
KENNEDY MEDICAL GROUP PRACTICE P.C.
Doing business as
Kennedy Health Alliance
Practice address
900 Route 168
Suite C#3
Blackwood, NJ 08012-3233
Phone
(856) 857-6920
NPI assigned
Feb 28, 2017
Last updated
Feb 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2017

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

Authorized official

Name
Carman A Ciervo, D.O.
Title
Cpe
Phone
(856) 344-7360

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU
Addiction (Substance Use Disorder) Psychologist 103TA0400X NU
Prescribing (Medical) Psychologist 103TP0016X NU Primary

Addresses

Primary practice location

900 Route 168
Suite C#3
Blackwood, NJ 08012-3233

Mailing address

900 Route 168
Suite C#3
Blackwood, NJ 08012-3233

Other identifiers 1

IdentifierTypeStateIssuer
0411248MedicaidNJ

Other names 1

  • Kennedy Health Alliance Doing business as

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

NPI Registry JSON

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

{
    "created_epoch": "1488240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488240000000",
    "number": "1497295109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 ROUTE 168",
            "address_2": "SUITE C#3",
            "city": "BLACKWOOD",
            "state": "NJ",
            "postal_code": "080123233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 ROUTE 168",
            "address_2": "SUITE C#3",
            "city": "BLACKWOOD",
            "state": "NJ",
            "postal_code": "080123233",
            "telephone_number": "856-857-6920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY MEDICAL GROUP PRACTICE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-28",
        "last_updated": "2017-02-28",
        "status": "A",
        "authorized_official_last_name": "CIERVO",
        "authorized_official_first_name": "CARMAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CPE",
        "authorized_official_telephone_number": "856-344-7360",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0411248",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kennedy Health Alliance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blackwood, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.