NPIMap

Organization Active NPI

Kennedy Medical Group Practice P.C.

  • Family Medicine Physician
  • Turnersville, NJ
National Provider Identifier
1881987337
Registry record updated Oct 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MB05175300 Issued in NJ
Legal business name
KENNEDY MEDICAL GROUP PRACTICE P.C.
Practice address
1 A Regulus Drive
Turnersville, NJ 08012
Phone
(856) 256-7513
Fax
(856) 256-7518
NPI assigned
May 17, 2011
Organization subpart
Yes
Parent organization
KENNEDY HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 19, 2017

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

Authorized official

Name
Carman A Ciervo
Title
Ceo
Phone
(856) 783-1987

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 25MB05175300 NJ Primary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X

Addresses

Primary practice location

1 A Regulus Drive
Turnersville, NJ 08012

Mailing address

1 A Regulus Drive
Turnersville, NJ 08012
Phone (856) 256-7513

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140613000689 NJ Part B Supplier - Clinic/Group Practice 2860616877 Receives reassigned benefits from 487 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sewell, NJ; Stratford, NJ; Turnersville, NJ; Voorhees, NJ; West Berlin, NJ; West Deptford, NJ; Woodbury, NJ; Marlton, NJ…

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Kennedy Medical Group Practice PC Dba Kennedy Health Alliance36 organizations share this tax ID, including this one
Part of
Kennedy Neph Hyper Asso

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

Locations

354 Hurffville Crosskeys Rd
Bldg 2
Sewell, NJ 08080
Phone (856) 566-3190

1 Regulus Dr
#A
Turnersville, NJ 08012
Phone (609) 589-7770

Practitioners & affiliated clinicians

Practitioners 65

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 65

NPI Registry JSON

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

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508371200000",
    "number": "1881987337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 A REGULUS DRIVE",
            "city": "TURNERSVILLE",
            "state": "NJ",
            "postal_code": "08012",
            "telephone_number": "856-256-7513",
            "fax_number": "856-256-7518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 A REGULUS DRIVE",
            "city": "TURNERSVILLE",
            "state": "NJ",
            "postal_code": "08012",
            "telephone_number": "856-256-7513",
            "fax_number": "856-256-7518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY MEDICAL GROUP PRACTICE P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENNEDY HEALTH SYSTEM",
        "enumeration_date": "2011-05-17",
        "last_updated": "2017-10-19",
        "status": "A",
        "authorized_official_last_name": "CIERVO",
        "authorized_official_first_name": "CARMAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "856-783-1987"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB05175300",
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Turnersville, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.