NPIMap

Organization Active NPI

Kennedy University Hospital, Inc

  • Primary Care Clinic/Center
  • Sewell, NJ
National Provider Identifier
1649296294
Registry record updated Mar 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
10802 Issued in NJ
Legal business name
KENNEDY UNIVERSITY HOSPITAL, INC
Practice address
445 Hurffville Crosskeys Rd BLDG a
Sewell, NJ 08080-2337
Phone
(856) 557-5555
Fax
(856) 218-2873
NPI assigned
Jul 15, 2006
Organization subpart
Yes
Parent organization
KENNEDY MEMORIAL HOSPITAL UNIVERSITY MEDICAL CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 4, 2020

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

Authorized official

Name
Mrs. Michelle Sills
Title
Office Manager
Phone
(856) 557-5555

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 10802 NJ
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X 10802 NJ
Primary Care Clinic/Center 261QP2300X 10802 NJ Primary

Addresses

Primary practice location

445 Hurffville Crosskeys Rd BLDG a
Sewell, NJ 08080-2337

Mailing address

445 Hurffville - Crosskeys Rd
Building a
Sewell, NJ 08080
Phone (856) 557-5555

Other identifiers 2

IdentifierTypeStateIssuer
6843301MedicaidNJ
4140222MedicaidNJ

Other names 1

  • KENNEDY FAMILY HEALTH SERVICES Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040719000006 NJ Part B Supplier - Clinic/Group Practice 3274442868 Receives reassigned benefits from 20 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sewell, NJ; Somerdale, NJ; Swedesboro, NJ; Cherry Hill, NJ

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Kennedy Neph Hyper Asso

Member organizations 8

Organizations listed as members of this organization in the National Provider Directory.

Locations

201 Laurel Oak Rd
#B
Voorhees, NJ 08043
Phone (856) 566-5478

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583280000000",
    "number": "1649296294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 HURFFVILLE - CROSSKEYS RD",
            "address_2": "BUILDING A",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "08080",
            "telephone_number": "856-557-5555",
            "fax_number": "856-218-2873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 HURFFVILLE CROSSKEYS RD BLDG A",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080802337",
            "telephone_number": "856-557-5555",
            "fax_number": "856-218-2873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY UNIVERSITY HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENNEDY MEMORIAL HOSPITAL UNIVERSITY MEDICAL CENTER, INC",
        "enumeration_date": "2006-07-15",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A",
        "authorized_official_last_name": "SILLS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "856-557-5555",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "10802",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "NJ",
            "license": "10802",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NJ",
            "license": "10802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6843301",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4140222",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KENNEDY FAMILY HEALTH SERVICES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KENNEDY FAMILY HEALTH SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sewell, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.