NPIMap

Organization Active NPI

Kennedy Medical Group Practice PC

Doing business as Kennedy Health Alliance

  • Family Medicine Physician
  • Sewell, NJ
National Provider Identifier
1952848905
Registry record updated Jan 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MA04155300 Issued in NJ
Legal business name
KENNEDY MEDICAL GROUP PRACTICE PC
Doing business as
Kennedy Health Alliance
Practice address
100 Kings Way E
Suite D2
Sewell, NJ 08080-2237
Phone
(856) 218-7730
Fax
(856) 218-4808
NPI assigned
Jan 30, 2017
Last updated
Jan 30, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2017

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

Authorized official

Name
Carmen Ciervo, DO
Title
Chief Executive Officer
Phone
(856) 566-5202

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25MA04155300 NJ Primary

Addresses

Primary practice location

100 Kings Way E
Suite D2
Sewell, NJ 08080-2237

Mailing address

1099 White Horse Rd
Voorhees, NJ 08043-4405
Phone (856) 566-5202

Other names 1

  • Kennedy Health Alliance Doing business as

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

Locations

401 Cooper Landing Rd
Ste C22
Cherry Hill, NJ 08002
Phone (856) 779-7779

511 Kings Hwy N
Cherry Hill, NJ 08034
Phone (609) 667-1654

63 Kresson Rd
Ste 103
Cherry Hill, NJ 08034
Phone (856) 427-9004

15 E Redman Ave
Ste A
Haddonfield, NJ 08033
Phone (844) 542-8273

412 Ewan Rd
Ste B
Mullica Hill, NJ 08062
Phone (856) 223-2669

300 S Black Horse Pike
Runnemede, NJ 08078
Phone (609) 931-3060

100 Kings Way E
Ste D2
Sewell, NJ 08080
Phone (856) 218-7730

400 Medical Center Dr
Ste F
Sewell, NJ 08080
Phone (856) 256-7705

707 Haddonfield Berlin Rd
Voorhees, NJ 08043
Phone (856) 857-6920

Practitioners & affiliated clinicians

Practitioners 457

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 457

NPI Registry JSON

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

{
    "created_epoch": "1485734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1952848905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1099 WHITE HORSE RD",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080434405",
            "telephone_number": "856-566-5202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 KINGS WAY E",
            "address_2": "SUITE D2",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080802237",
            "telephone_number": "856-218-7730",
            "fax_number": "856-218-4808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY MEDICAL GROUP PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-30",
        "last_updated": "2017-01-30",
        "status": "A",
        "authorized_official_last_name": "CIERVO",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "856-566-5202",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA04155300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kennedy Health Alliance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sewell, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.