Individual provider Active NPI

Mikel Shea Ehntholt

  • Neurology Physician
  • Camden, NJ
National Provider Identifier
1790139780
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
25MA11936200 Issued in NJ
Practice address
1600 Haddon Ave FL 6
Camden, NJ 08103-3101
Phone
(856) 757-3500
NPI assigned
Apr 16, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Neurology Physician 2084N0400X 25MA11936200 NJ Primary
Psychiatry Physician 2084P0800X 25MA11936200 NJ

Addresses

Primary practice location

1600 Haddon Ave FL 6
Camden, NJ 08103-3101

Mailing address

301 Lippincott Dr Ste 410
Marlton, NJ 08053-4197

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
I20230913001566 NJ Practitioner - Neurology 2264896000 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians

Practice addresses (Care Compare)

1600 Haddon Ave
Camden, NJ 08103-3101
Phone (856) 757-3500

Hospital & facility affiliations

  • Virtua Our Lady of Lourdes Hospital Hospital, Camden, NJ, CCN 310029
  • West Jersey Hospital Hospital, Voorhees, NJ, CCN 310022
  • Virtua Mount Holly Hospital Hospital, Mount Holly, NJ, CCN 310057

Merit-based Incentive Payment System (MIPS)

Final score
81.15 of 100Reported as group
Quality
62.28
Promoting interoperability
100
Improvement activities
40
Cost
74.89

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA CurrentSince Aug 1, 2023 Accepting new patients
Virtua Medical Group, PA CurrentSince Aug 1, 2023 Accepting new patients
Virtua Medical Group, PA Current Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

1600 Haddon Ave
Fl 6
Camden, NJ 08103
Phone (856) 247-2160

303 Lippincott Dr
Ste 200
Marlton, NJ 08053
Phone (856) 355-0335

301 Lippincott Dr
Ste 410
Marlton, NJ 08053

Interoperability endpoints

  • Direct secure messaging: mehntholt256517@directvirtua.org

Organizations & group practices 3

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 3

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": "1460764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1790139780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LIPPINCOTT DR STE 410",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 HADDON AVE FL 6",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081033101",
            "telephone_number": "856-757-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EHNTHOLT",
        "first_name": "MIKEL",
        "middle_name": "SHEA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-16",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NJ",
            "license": "25MA11936200",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA11936200",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camden, NJ

Sources for this page

Verify at the official NPI Registry.