Fennel Edward Kpolie, LSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

44SL05587600 Issued in NJ

Practice address

1239 Parkway Ave Ste 102
Ewing, NJ 08628-3000

Phone

(609) 394-3010

Fax

(609) 394-3010

NPI assigned

Aug 27, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DE, NJ2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Social Worker

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Christiana Care Health Services IncGroup PAC ID 9739097569, 1,480 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Christiana Hospital Hospital, Newark, DE, CCN 080001

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/5c7467fb-60f9-4172-add4-57667a5dfcfa/

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.

• Christiana Care Health Services, Inc

  • Endocrinology, Diabetes & Metabolism Physician
  • Wilmington, DE
  • NPI 1770568107

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Grow Healthcare Group of New Jersey PC

  • Mental Health Counselor
  • Hoboken, NJ
  • NPI 1841949328

  Clinical

  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, DE

  Medicare reassignment NPD
• Penn-Jersey Integrated Human Services Inc

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Philadelphia, PA
  • NPI 1427531698
  NPD Authorized official
• Christiana Care Health Services Inc

  • Neurology Physician
  • Chadds Ford, PA
  • NPI 1881228484
  NPD
• Christiana Care Health Services, Inc

  • Psychiatry Physician
  • Wilmington, DE
  • NPI 1083699433

  Social Worker

  NPD
• Christiana Care Health Services Inc

  • Infectious Disease Physician
  • Wilmington, DE
  • NPI 1326022476

  Single Specialty

  NPD (past)
• Christiana Care Health Services, Inc

  • Cardiovascular Disease Physician
  • Newark, DE
  • NPI 1003850504

  Single Specialty

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Christiana Care Health Services, Inc.

  • General Acute Care Hospital
  • Wilmington, DE
  • NPI 1134194038
  Care Compare affiliation

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

{
    "created_epoch": "1566864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653955200000",
    "number": "1811545627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4512 KIRKWOOD HWY",
            "address_2": "STE 300",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198085129",
            "telephone_number": "302-623-7515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1239 PARKWAY AVE STE 102",
            "city": "EWING",
            "state": "NJ",
            "postal_code": "086283000",
            "telephone_number": "609-394-3010",
            "fax_number": "609-394-3010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KPOLIE",
        "first_name": "FENNEL",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "LSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-27",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "DE",
            "license": "Q1-0012005",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NJ",
            "license": "44SL05587600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Donna Korpusinski, PTA
• Joan Koslowske
• Kostinas Chiropractic, LLC
• James John Kostinas, D.C.
• Richard Kozlowski, RPH
• Jacqueline Kraft, LAC
• Shaismy Kudakachira, D.O.
• Barbara Elaine Kuti
• Kwenyan and Associates
• Kwenyan and Associates

• Social Worker in Ewing, NJ
• Providers in Ewing, NJ by specialty
• Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.