Individual provider Active NPI

Edward Reis, MD

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1578597043
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA06148200 Issued in NJ
Practice address
39TH and Filbert Streets
Medical Arts Building, Suite 212
Philadelphia, PA 19104
Phone
(215) 662-8978
Fax
(215) 662-5940
NPI assigned
Jul 10, 2006
Last updated
Jun 23, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD049808L PA
Internal Medicine Physician 207R00000X 25MA06148200 NJ Primary

Addresses

Primary practice location

39TH and Filbert Streets
Medical Arts Building, Suite 212
Philadelphia, PA 19104

Mailing address

443 Laurel Oak Rd Ste 130
Voorhees, NJ 08043-4419
Phone (844) 542-2273

Other practice location 1

443 Laurel Oak Rd Ste 130
Voorhees, NJ 08043-4419
Phone (844) 542-2273

Other identifiers 1

IdentifierTypeStateIssuer
001446042MedicaidPA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210629000571 NJ Practitioner - Internal Medicine 5193852689 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

443 Laurel Oak Rd
Voorhees, NJ 08043-4419
Phone (844) 542-2273

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy Medical Group Practice, P.C. Internal Medicine CurrentSince Jul 1, 2021 Accepting new patients
Kennedy Medical Group Practice, P.C. Internal Medicine CurrentSince Jun 15, 2021 Accepting new patients
Kennedy Medical Group Practice PC CurrentSince Jul 1, 2021 Accepting new patients
Kennedy Medical Group Practice P.C. Past Accepting new patients

Locations

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

151 Fries Mill Rd
Ste 301
Turnersville, NJ 08012
Phone (856) 374-1881

443 Laurel Oak Rd
Voorhees, NJ 08043
Phone (215) 456-4985

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1578597043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "443 LAUREL OAK RD STE 130",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080434419",
            "telephone_number": "844-542-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39TH AND FILBERT STREETS",
            "address_2": "MEDICAL ARTS BUILDING, SUITE 212",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-662-8978",
            "fax_number": "215-662-5940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "443 Laurel Oak Rd Ste 130",
            "address_purpose": "LOCATION",
            "city": "Voorhees",
            "state": "NJ",
            "postal_code": "080434419",
            "country_code": "US",
            "telephone_number": "844-542-2273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REIS",
        "first_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD049808L",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA06148200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001446042",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.