NPIMap

Individual provider Active NPI

Tamara Anne Lacouture, M.D.

  • Therapeutic Radiology Physician
  • Sewell, NJ
National Provider Identifier
1740287721
Registry record updated Feb 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Therapeutic Radiology PhysicianTaxonomy code 2085R0203X
License
25MA06314000 Issued in NJ
Practice address
900 Medical Center Dr Ste 100
Sewell, NJ 08080
Phone
(856) 582-3008
NPI assigned
Jul 5, 2005
Last updated
Feb 10, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Therapeutic Radiology Physician 2085R0203X 25MA06314000 NJ Primary

Addresses

Primary practice location

900 Medical Center Dr Ste 100
Sewell, NJ 08080

Mailing address

900 Medical Center Dr Ste 100
Sewell, NJ 08080-2358
Phone (856) 582-3008

Other practice location 1

750 Route 73 S
Ste 401
Marlton, NJ 08053-4145
Phone (856) 797-1507

Other identifiers 1

IdentifierTypeStateIssuer
7990405MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040812000515 NJ Practitioner - Radiation Oncology 7810969425 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Rutgers R W Johnson Medical School (Cam/New Bruns/Pisc), 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

900 Medical Ctr Dr
Suite 100
Sewell, NJ 08080-2358
Phone (856) 582-3008

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Radiation Oncology, PC CurrentSince May 1, 2007 Accepting new patients
Kennedy Medical Group Practice, P.C. CurrentSince Nov 15, 2015 Accepting new patients
Kennedy Medical Group Practice, P.C. CurrentSince Oct 27, 2019 Accepting new patients
Kennedy Medical Group Practice PC CurrentSince Nov 15, 2015 Accepting new patients
Rabc Therapy LLC Past Accepting new patients
Urological Associates, PC Past Accepting new patients
Kennedy Medical Group Practice P.C. Past Accepting new patients

Locations

1 Cooper Plz
Camden, NJ 08103
Phone (856) 342-2425

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

900 Medical Center Dr
Ste 100
Sewell, NJ 08080
Phone (856) 582-3006

400 Laurel Oak Rd
Ste 105
Voorhees, NJ 08043
Phone (609) 304-0991

9908 Roosevelt Blvd
Philadelphia, PA 19115
Phone (215) 464-3300

Organizations & group practices 7

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": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1740287721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 MEDICAL CENTER DR STE 100",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080802358",
            "telephone_number": "856-582-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 MEDICAL CENTER DR STE 100",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "08080",
            "telephone_number": "856-582-3008"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 Route 73 S",
            "address_2": "Ste 401",
            "address_purpose": "LOCATION",
            "city": "Marlton",
            "state": "NJ",
            "postal_code": "080534145",
            "country_code": "US",
            "telephone_number": "856-797-1507",
            "fax_number": "856-797-1597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LACOUTURE",
        "first_name": "TAMARA",
        "middle_name": "ANNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-05",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "NJ",
            "license": "25MA06314000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7990405",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sewell, NJ

Sources for this page

Verify at the official NPI Registry.