Individual provider Active NPI

Kimberly Ann Hagen, PA

  • Physician Assistant
  • Moorestown, NJ
National Provider Identifier
1811555709
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1163559 Issued in NJ
Practice address
728 Marne Hwy Ste 200a
Moorestown, NJ 08057-3128
Phone
(856) 291-8855
NPI assigned
Jun 5, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1163559 NJ Primary

Addresses

Primary practice location

728 Marne Hwy Ste 200a
Moorestown, NJ 08057-3128

Mailing address

301 Lippincott Dr Ste 410
Marlton, NJ 08053-4197
Phone (856) 355-0340

Other practice location 1

222 Schanck Rd Ste 104
Freehold, NJ 07728-2974
Phone (732) 431-1332

Other practice location 2

11 Meridian Rd
Eatontown, NJ 07724-2242
Phone (732) 663-0300

Electronic endpoints 4

TypeEndpointUseAffiliation
Direct Messaging Address khagen257831@directvirtua.org
Direct Messaging Address khagen257831@directvirtua.org
Direct Messaging Address khagen257831@directvirtua.org
Direct Messaging Address khagen257831@directvirtua.org

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190814001202 NJ Practitioner - Physician Assistant 9032446026 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
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)

175 Madison Ave
Mount Holly, NJ 08060-2038

3242 Route 206
Bordentown, NJ 08505-4517

728 Marne Hwy
Moorestown, NJ 08057-3128

Hospital & facility affiliations

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1163559NJMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA Physician Assistant CurrentSince Oct 1, 2023 Accepting new patients
Central Jersey Urgent Care CurrentSince Mar 19, 2021 Accepting new patients
Virtua Medical Group, PA CurrentSince Oct 1, 2023 Accepting new patients
Central Jersey Urgent Care CurrentSince Mar 19, 2021 Accepting new patients
Virtua Medical Group, PA PastSince Sep 10, 2023 Accepting new patients

Locations

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

1 Sheffield Dr
Ste 201
Columbus, NJ 08022
Phone (609) 291-8855

301 Lippincott Dr
Ste 410
Marlton, NJ 08053

128 Route 70
Ste 1B
Medford, NJ 08055
Phone (856) 206-4786

298 Applegarth Rd
Ste B
Monroe Township, NJ 08831
Phone (609) 409-0600

731 State Route 35
Unit G
Ocean, NJ 07712
Phone (732) 455-8444

Interoperability endpoints

  • Direct secure messaging: khagen@mca.gwaydirect.com

Organizations & group practices 5

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 4

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": "1559692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1811555709",
    "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",
            "telephone_number": "856-355-0340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "728 MARNE HWY STE 200A",
            "city": "MOORESTOWN",
            "state": "NJ",
            "postal_code": "080573128",
            "telephone_number": "856-291-8855"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "222 Schanck Rd Ste 104",
            "address_purpose": "LOCATION",
            "city": "Freehold",
            "state": "NJ",
            "postal_code": "077282974",
            "country_code": "US",
            "telephone_number": "732-431-1332",
            "fax_number": "732-431-1712",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11 Meridian Rd",
            "address_purpose": "LOCATION",
            "city": "Eatontown",
            "state": "NJ",
            "postal_code": "077242242",
            "country_code": "US",
            "telephone_number": "732-663-0300",
            "fax_number": "732-663-0301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAGEN",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-05",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "1163559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "khagen257831@directvirtua.org",
            "affiliation": "N",
            "address_1": "1 Sheffield Dr Ste 201",
            "city": "Columbus",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080229506",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "khagen257831@directvirtua.org",
            "affiliation": "N",
            "address_1": "128 Route 70 Ste 1B",
            "city": "Medford",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080552371",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "khagen257831@directvirtua.org",
            "affiliation": "N",
            "address_1": "728 Marne Hwy Ste 200A",
            "city": "Moorestown",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080573128",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "khagen257831@directvirtua.org",
            "affiliation": "N",
            "address_1": "6500 K Johnson Blvd Ste 100C",
            "city": "Bordentown",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "085052282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Moorestown, NJ

Sources for this page

Verify at the official NPI Registry.