Mark Condoluci, D.O.

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

License

25MB09385700 Issued in NJ

Practice address

709 Haddonfield Berlin Rd
Garden State Infectious Diseases Associates, P.a.
Voorhees, NJ 08043-3715

Phone

(856) 566-3190

Fax

(856) 783-2193

NPI assigned

Jul 2, 2010

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

Other identifiers 1

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

Specialty

Infectious DiseaseAlso: Internal Medicine

Education

Philadelphia College of Osteopathic Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Kennedy Medical Group Practice, P.C.Group PAC ID 2860616877, 417 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jefferson Stratford Hospital Hospital, Stratford, NJ, CCN 310086
• Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174
• Cooper University Hospital Hospital, Camden, NJ, CCN 310014

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Kennedy Medical Group Practice, P.C.

  • Family Medicine Physician
  • Voorhees, NJ
  • NPI 1952726796

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Kennedy Medical Group Practice P.C.

  • Internal Medicine Physician
  • Sicklerville, NJ
  • NPI 1023374766
  NPD
• Kennedy Medical Group Practice PC

  • Family Medicine Physician
  • Sewell, NJ
  • NPI 1952848905
  NPD
• Kennedy Medical Group Practice P.C.

  • Family Medicine Physician
  • West Deptford, NJ
  • NPI 1952615981
  NPD (past)

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

• Kennedy University Hospital Inc.

  • General Acute Care Hospital
  • Stratford, NJ
  • NPI 1386746592
  Care Compare affiliation
• The Cooper Health System

  • Land Ambulance
  • Camden, NJ
  • NPI 1174976724

  Hospital

  Care Compare affiliation
• The Cooper Health System

  • General Acute Care Hospital
  • Camden, NJ
  • NPI 1568442309
  Care Compare affiliation
• Thomas Jefferson University Hospitals Inc

  • General Acute Care Hospital
  • Philadelphia, PA
  • NPI 1215916002
  Care Compare affiliation

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

{
    "created_epoch": "1278028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488240000000",
    "number": "1851603120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 HADDONFIELD BERLIN RD",
            "address_2": "GARDEN STATE INFECTIOUS DISEASES ASSOCIATES, P.A.",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080433715",
            "telephone_number": "856-566-3190",
            "fax_number": "856-783-2193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 HADDONFIELD BERLIN RD",
            "address_2": "GARDEN STATE INFECTIOUS DISEASES ASSOCIATES, P.A.",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080433715",
            "telephone_number": "856-566-3190",
            "fax_number": "856-783-2193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONDOLUCI",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-02",
        "last_updated": "2017-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MB09385700",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NJ",
            "license": "25MB09385700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0476137",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Complete Care at Kresson View LLC
• Complete Care at Voorhees LLC
• Comprehensive Cancer & Hematology Specialists, P.C.
• Comprehensive Family Dentistry
• David V Condoluci, D.O.
• Rachel Conti, DPT
• Continuum Home Healthcare LLC
• Joshua William Cook, PHARMD
• Lauren Coombs
• Cooper Medical Supply

• Infectious Disease Physician in Voorhees, NJ
• Providers in Voorhees, NJ by specialty
• Infectious Disease Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; 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.