Kenneth Paul Michelette, NURSE PRACTITIONER

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

26NJ01060700 Issued in NJ

Practice address

72 W Jimmie Leeds Rd Ste 2500
Galloway, NJ 08205-9413

Phone

(609) 377-5133

NPI assigned

Oct 6, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Atlanticare Physician Group PAGroup PAC ID 8527953660, 506 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Atlanticare Physician Group PA

  • Clinic/Center
  • Egg Harbor Township, NJ
  • NPI 1093829608
  Medicare reassignment Care Compare group NPD
• Atlanticare Physician Group, PA

  • Urgent Care Clinic/Center
  • Galloway, NJ
  • NPI 1003820622
  NPD
• Atlanticare Physician Group

  • Primary Care Clinic/Center
  • Ventnor City, NJ
  • NPI 1194839910
  NPD (past)
• Atlanticare Urgent Care Physicians LLC

  • Urgent Care Clinic/Center
  • Sicklerville, NJ
  • NPI 1083991616
  NPD (past)

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

{
    "created_epoch": "1601942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1851998488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 ENGLISH CREEK AVE",
            "city": "EGG HARBOR TOWNSHIP",
            "state": "NJ",
            "postal_code": "082345549",
            "telephone_number": "609-407-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 W JIMMIE LEEDS RD STE 2500",
            "city": "GALLOWAY",
            "state": "NJ",
            "postal_code": "082059413",
            "telephone_number": "609-377-5133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHELETTE",
        "first_name": "KENNETH",
        "middle_name": "PAUL",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-06",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NJ",
            "license": "26NJ01060700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yatish B Merchant, MD
• Janine Merendino, RN
• Roman Gregory Meyliker, DMD
• Sun Miao, MD
• Wedad S Michael, M.D.
• Lauren Elizabeth Michelfelder, LSW
• Dangelo Martino Milford, MSW, LCSW
• Biyonka Iyana Miller-Hampton
• Mindfully Active Karver Counseling & Wellness LLC
• Minimally Invasive Surgeons of South Jersey LLC

• Pain Medicine (Anesthesiology) Physician in Galloway, NJ
• Providers in Galloway, NJ by specialty
• Pain Medicine (Anesthesiology) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; 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.