NPIMap

Organization Active NPI

Kennedy Medical Group Practice, P.C.

Doing business as Kennedy Health Alliance

  • Obstetrics Physician
  • Blackwood, NJ
National Provider Identifier
1932511987
Registry record updated Jul 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics PhysicianTaxonomy code 207VX0000X
Legal business name
KENNEDY MEDICAL GROUP PRACTICE, P.C.
Doing business as
Kennedy Health Alliance
Practice address
188 Fries Mill Rd
Suite N3
Blackwood, NJ 08012-2015
Phone
(856) 875-0505
Fax
(856) 875-9556
NPI assigned
May 27, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2015

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

Authorized official

Name
Katherine Schleider
Title
Vpclinical Integration & Population
Phone
(856) 783-1987

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VX0000X NJ Primary

Addresses

Primary practice location

188 Fries Mill Rd
Suite N3
Blackwood, NJ 08012-2015

Mailing address

205 E Laurel Rd
2ND Floor
Stratford, NJ 08084-1301
Phone (856) 783-1987

Other identifiers 2

IdentifierTypeStateIssuer
3911101MedicaidNJ
P00633440OtherNJRAILROAD MEDICARE

Other names 1

  • Kennedy Health Alliance Doing business as

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

Other organizations with this tax ID 35

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

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1401148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435708800000",
    "number": "1932511987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 E LAUREL RD",
            "address_2": "2ND FLOOR",
            "city": "STRATFORD",
            "state": "NJ",
            "postal_code": "080841301",
            "telephone_number": "856-783-1987",
            "fax_number": "856-783-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 FRIES MILL RD",
            "address_2": "SUITE N3",
            "city": "BLACKWOOD",
            "state": "NJ",
            "postal_code": "080122015",
            "telephone_number": "856-875-0505",
            "fax_number": "856-875-9556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY MEDICAL GROUP PRACTICE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-27",
        "last_updated": "2015-07-01",
        "status": "A",
        "authorized_official_last_name": "SCHLEIDER",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_title_or_position": "VPCLINICAL INTEGRATION & POPULATION",
        "authorized_official_telephone_number": "856-783-1987"
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3911101",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00633440",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kennedy Health Alliance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blackwood, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.