Individual provider Active NPI

Caryn K Bandy, DO

  • Family Medicine Physician
  • Williamstown, NJ
National Provider Identifier
1851301618
Registry record updated Dec 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MB06951000 Issued in NJ
Practice address
979 N Black Horse Pike
Williamstown, NJ 08094-1044
Phone
(856) 629-5151
Fax
(856) 629-0281
NPI assigned
Aug 8, 2006
Last updated
Dec 21, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25MB06951000 NJ Primary

Addresses

Primary practice location

979 N Black Horse Pike
Williamstown, NJ 08094-1044

Mailing address

402 Lippincott Dr
Marlton, NJ 08053-4112
Phone (856) 782-3300

Other names 1

  • Caryn Nicholls Former name

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
I20080422000267 NJ Practitioner - Family Practice 5597843201 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rutgers New Jersey Medical School, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Advocare, LLCGroup PAC ID 3678562188, 383 clinicians

Practice addresses (Care Compare)

132 Grove St
Suite a
Haddonfield, NJ 08033-1224
Phone (856) 354-2211

979 N Black Horse Pike
Advocare Nephrology of South Jersey
Williamstown, NJ 08094-1044
Phone (856) 424-7390

979 N Black Horse Pke
Williamstown, NJ 08094-1044
Phone (856) 629-5151

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MB06951000NJMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocare, LLC Family Medicine CurrentSince Apr 1, 2008 Accepting new patients
Advocare , LLC CurrentSince Apr 1, 2008 Accepting new patients
Advocare, LLC Past Accepting new patients

Locations

169 Mine Brook Rd
#P
Bernardsville, NJ 07924
Phone (908) 766-0034

132 Grove St
Ste A
Haddonfield, NJ 08033
Phone (856) 354-2211

401 Route 73 N
Ste 320
Marlton, NJ 08053
Phone (609) 471-1033

402 Lippincott Dr
Marlton, NJ 08053
Phone (410) 763-8787

979 N Black Horse Pike
Williamstown, NJ 08094
Phone (856) 629-5151

Interoperability endpoints

  • Direct secure messaging: caryn.bandy@advocaredoctors.eclinicaldirectplus.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545350400000",
    "number": "1851301618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 LIPPINCOTT DR",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534112",
            "telephone_number": "856-782-3300",
            "fax_number": "856-504-8029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "979 N BLACK HORSE PIKE",
            "city": "WILLIAMSTOWN",
            "state": "NJ",
            "postal_code": "080941044",
            "telephone_number": "856-629-5151",
            "fax_number": "856-629-0281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANDY",
        "first_name": "CARYN",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-08",
        "last_updated": "2018-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB06951000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARYN",
            "last_name": "NICHOLLS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Williamstown, NJ

Sources for this page

Verify at the official NPI Registry.