Individual provider Active NPI

Zelda Shimba Wasao, MD

  • Internal Medicine Physician
  • El Paso, TX
National Provider Identifier
1598321978
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA11891500 Issued in NJ
Practice address
10301 Gateway Blvd W
El Paso, TX 79925-7701
Phone
(915) 595-9000
NPI assigned
May 11, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 25MA11891500 NJ Primary

Addresses

Primary practice location

10301 Gateway Blvd W
El Paso, TX 79925-7701

Mailing address

333 Laurel Oak Rd Ste B
Voorhees, NJ 08043-4453
Phone (856) 513-4124

Other practice location 1

435 Hurffville Cross Keys Rd
Turnersville, NJ 08012
Phone (856) 513-4124

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
I20230724004155 NJ Practitioner - Internal Medicine 0941660823 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kennedy Medical Group Practice, P.C.Group PAC ID 2860616877, 417 clinicians

Practice addresses (Care Compare)

435 Hurffville Cross Keys Rd
Turnersville, NJ 08012-2453
Phone (856) 513-4124

Hospital & facility affiliations

  • Jefferson Stratford Hospital Hospital, Stratford, NJ, CCN 310086
  • Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174

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 Jun 15, 2021 Accepting new patients
Kennedy Medical Group Practice PC CurrentSince Jul 1, 2023 Accepting new patients
Kennedy Medical Group Practice P.C. CurrentSince Jul 1, 2023 Accepting new patients
Kennedy University Hospital Inc. Past Accepting new patients

Locations

2201 Chapel Ave W
Cherry Hill, NJ 08002
Phone (856) 488-6500

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

435 Hurffville Cross Keys Rd
Turnersville, NJ 08012
Phone (856) 513-4124

333 Laurel Oak Rd
Ste B
Voorhees, NJ 08043
Phone (856) 513-4124

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.

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": "1557532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1598321978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 LAUREL OAK RD STE B",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080434453",
            "telephone_number": "856-513-4124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10301 GATEWAY BLVD W",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799257701",
            "telephone_number": "915-595-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "435 Hurffville Cross Keys Rd",
            "address_purpose": "LOCATION",
            "city": "Turnersville",
            "state": "NJ",
            "postal_code": "08012",
            "country_code": "US",
            "telephone_number": "856-513-4124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WASAO",
        "first_name": "ZELDA",
        "middle_name": "SHIMBA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-11",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA11891500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.