Kevin J Mickey, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

25MA05006300 Issued in NJ

Practice address

57 Willowbrook Blvd
Suite 411
Wayne, NJ 07470-7045

Phone

(973) 256-4111

Fax

(973) 256-3719

NPI assigned

Jun 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Consensus Medical Group LLCGroup PAC ID 2961748181, 138 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kmickey53509@direct.ahsys.org

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.

• Consensus Medical Group LLC

  • Internal Medicine Physician
  • Manasquan, NJ
  • NPI 1811466881
  Medicare reassignment Care Compare group NPD
• St Josephs Medical Group PC

  • Internal Medicine Physician
  • Paterson, NJ
  • NPI 1205425519
  Medicare reassignment NPD
• St. Joseph's Healthcare, Inc.

  • Internal Medicine Physician
  • Paterson, NJ
  • NPI 1497791297
  Medicare reassignment NPD

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587340800000",
    "number": "1538101662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 WILLOWBROOK BLVD",
            "address_2": "SUITE 411",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074707045",
            "telephone_number": "973-256-4111",
            "fax_number": "973-256-3719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 WILLOWBROOK BLVD",
            "address_2": "SUITE 411",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074707045",
            "telephone_number": "973-256-4111",
            "fax_number": "973-256-3719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKEY",
        "first_name": "KEVIN",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NJ",
            "license": "25MA05006300",
            "primary": true
        },
        {
            "code": "207WX0110X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist",
            "state": "NJ",
            "license": "25MA05006300",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1141708",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "25MA05006300",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mferra Therapy and Wellness, LLC (Balanced Mind, Therapy for Individuals and Families)
• Michael H Bernstein MD PA
• Michael Kesler, D.P.M., P.C.
• Michael L. Sakowitz PH.D., P.a,
• Michael S. Mattikow, M.D., P.a.
• Katy Mierta, APN
• Hany A Mikhail
• Edward Milano, M.D.
• Jansenia Diane Millares, MSN, APRN, FNP-C
• Millennium Physical Therapy II, LLC

• Ophthalmology Physician in Wayne, NJ
• Providers in Wayne, NJ by specialty
• Ophthalmology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.