Individual provider Active NPI

Keely Elizabeth Eckberg, FNP

  • Family Nurse Practitioner
  • Manahawkin, NJ
National Provider Identifier
1972146355
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
26NJ0100800 Issued in NJ
Practice address
1361 Route 72 W
Manahawkin, NJ 08050-2417
Phone
(609) 978-0600
NPI assigned
Oct 18, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN1030434 DC
Family Nurse Practitioner 363LF0000X 26NJ0100800 NJ Primary

Addresses

Primary practice location

1361 Route 72 W
Manahawkin, NJ 08050-2417

Mailing address

1011 Arlington Blvd Apt 404
Arlington, VA 22209-2205
Phone (732) 403-1989

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200221001355 NJ Practitioner - Nurse Practitioner 4587091053 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regional Womens Health Group LLCGroup PAC ID 2961316328, 352 clinicians

Practice addresses (Care Compare)

4622 Black Horse Pike
Suite 104
Mays Landing, NJ 08330-3214
Phone (609) 625-9610

Hospital & facility affiliations

  • Shore Medical Center Hospital, Somers Point, NJ, CCN 310047

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN1030434DCMDRegistered Nurse
26NJ0100800NJMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Regional Womens Health Group LLC CurrentSince Feb 1, 2024 Accepting new patients
Regional Women'S Health Group, LLC CurrentSince Feb 1, 2024 Accepting new patients

Locations

605 Route 9 S
Ste 4
Cape May Court House, NJ 08210
Phone (609) 463-8100

76 W Jimmie Leeds Rd
Ste 104
Galloway, NJ 08205
Phone (609) 748-6696

338 Belleville Tpke
Kearny, NJ 07032
Phone (201) 991-3838

4622 Black Horse Pike
Ste 104
Mays Landing, NJ 08330
Phone (609) 625-9610

312 Applegarth Rd
Ste 102
Monroe Twp, NJ 08831
Phone (732) 536-5552

599 Shore Rd
Ste 101
Somers Point, NJ 08244
Phone (609) 926-8353

829 Shore Rd
Somers Point, NJ 08244
Phone (609) 927-3070

188 Fries Mill Rd
Ste N1
Turnersville, NJ 08012
Phone (609) 261-7023

227 Laurel Rd
Ste 300
Voorhees, NJ 08043
Phone (856) 669-6025

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1571356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581465600000",
    "number": "1972146355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 ARLINGTON BLVD APT 404",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222092205",
            "telephone_number": "732-403-1989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1361 ROUTE 72 W",
            "city": "MANAHAWKIN",
            "state": "NJ",
            "postal_code": "080502417",
            "telephone_number": "609-978-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ECKBERG",
        "first_name": "KEELY",
        "middle_name": "ELIZABETH",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-18",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "DC",
            "license": "RN1030434",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ0100800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manahawkin, NJ

Sources for this page

Verify at the official NPI Registry.