NPIMap

Organization Active NPI

Our Family Practice LLC

  • Non-Pharmacy Dispensing Site
  • Brick, NJ
National Provider Identifier
1811201189
Registry record updated Oct 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
25MA05883600 Issued in NJ
Legal business name
OUR FAMILY PRACTICE LLC
Practice address
1899 State Highway 88
Brick, NJ 08724-3124
Phone
(732) 840-8177
NPI assigned
Jul 29, 2010
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 23, 2012

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

Authorized official

Name
Kenny Heine
Title
Sr. Director Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 25MA05883600 NJ Primary

Addresses

Primary practice location

1899 State Highway 88
Brick, NJ 08724-3124

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705

Other names 1

  • Our Family Practice Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Our Family Practice2 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1899 State Highway 88
Brick, NJ 08724
Phone (732) 840-8177

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/28485/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1280361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350950400000",
    "number": "1811201189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1899 STATE HIGHWAY 88",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087243124",
            "telephone_number": "732-840-8177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR FAMILY PRACTICE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2010-07-29",
        "last_updated": "2012-10-23",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "SR. DIRECTOR OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NJ",
            "license": "25MA05883600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Our Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brick, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.