Active NPI
Mark L Kavanagh, MD
- Orthopaedic Surgery Physician
- Lincoln Park, NJ
National Provider Identifier
1558514380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 25MA08991900
- Practice address
- 61 Beaverbrook Rd
Suite 201
Lincoln Park, NJ 07035-1748 - Phone
- (973) 686-9292
- Fax
- (973) 686-9294
- NPI assigned
- Oct 24, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Orthopaedic Surgery) Physician | 207XX0005X | 0101245447 | VA | |
| Orthopaedic Surgery Physician | 207X00000X | 25MA08991900 | NJ | Primary |
Addresses
Primary practice location
61 Beaverbrook Rd
Suite 201
Lincoln Park, NJ 07035-1748
Mailing address
61 Beaverbrook Rd
Suite 201
Lincoln Park, NJ 07035-1748
Phone (973) 686-9292
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558514380 | Other | VA | BCBS |
| 1558514380 | Medicaid | VA |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Orthopedic Surgery
- Education
- Eastern Virginia Medical School, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1 Diamond Hill Rd
Berkeley Heights, NJ 07922-2104
Phone (908) 273-4300
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Lower limb (leg) arthroscopy (minimally invasive joint repair) | 1-10 |
| Upper limb (arm) arthroscopy (minimally invasive joint repair) | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Medical Group PA | Current | Accepting new patients | |
| Summit Medical Group PA | Orthopaedic Surgery | Current | Accepting new patients |
| Southside Physician Network LLC | Orthopaedic Surgery | Past | Accepting new patients |
| Summit Medical Group, Inc | Past | Accepting new patients |
Locations
1 Diamond Hill Rd
Berkeley Heights, NJ 07922
Phone (908) 277-8868
1255 Broad St
Clifton, NJ 07013
Phone (973) 471-0981
150 Floral Ave
New Providence, NJ 07974
Phone (908) 588-3890
Interoperability endpoints
- mark.kavanagh.1@2983.direct.athenahealth.com
- https://api.platform.athenahealth.com/679/brand/1/csg/319/fhir/r4
Organizations & group practices 4
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.
-
- Multi-Specialty Clinic/Center
- Berkeley Heights, NJ
- NPI 1942254347
-
- Durable Medical Equipment & Medical Supplies
- Hackensack, NJ
- NPI 1043930555
Orthopaedic Surgery
-
- Internal Medicine Physician
- Colonial Heights, VA
- NPI 1811146194
Orthopaedic Surgery
-
dba St. Elizabeth Physicians
- Family Medicine Physician
- Erlanger, KY
- NPI 1750343216
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Kessler Rehabilitation Center
- Rehabilitation Hospital
- West Orange, NJ
- NPI 1013919620
Inpatient rehabilitation facility
-
- General Acute Care Hospital
- Paterson, NJ
- NPI 1669462420
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388620800000",
"number": "1558514380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "61 BEAVERBROOK RD",
"address_2": "SUITE 201",
"city": "LINCOLN PARK",
"state": "NJ",
"postal_code": "070351748",
"telephone_number": "973-686-9292",
"fax_number": "973-686-9294"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "61 BEAVERBROOK RD",
"address_2": "SUITE 201",
"city": "LINCOLN PARK",
"state": "NJ",
"postal_code": "070351748",
"telephone_number": "973-686-9292",
"fax_number": "973-686-9294"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAVANAGH",
"first_name": "MARK",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-24",
"last_updated": "2014-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "207XX0005X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Sports Medicine",
"state": "VA",
"license": "0101245447",
"primary": false
},
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "NJ",
"license": "25MA08991900",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "1558514380",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1558514380",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lincoln Park, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2014; 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.