KENILWORTH PRIMARY CARE LLC
NPI 1164793014
Clinic/Center - Primary Care in Kenilworth, NJ
About Kenilworth Primary Care Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KENILWORTH PRIMARY CARE LLC (NPI 1164793014) is a healthcare organization registered as a primary care in Kenilworth, New Jersey and active in the NPI registry since January 2012. The organization holds a CLIA Waiver certificate valid through May 8, 2028 and lists Bhavani Jeereddy, Sole Member, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kenilworth Primary Care Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Kenilworth Primary Care LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 31D2040770
Kenilworth Primary Care · Kenilworth, NJFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kenilworth Primary Care LLC's NPI number?
The NPI number for Kenilworth Primary Care LLC is 1164793014. It was assigned to this organization in the NPPES registry on January 24, 2012.
Where is Kenilworth Primary Care LLC located?
Kenilworth Primary Care LLC is located at 66 S 21st St, Kenilworth, NJ 07033. The listed phone number is (908) 276-9595.
What is Kenilworth Primary Care LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Kenilworth Primary Care LLC enrolled in Medicare?
Yes. Kenilworth Primary Care LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Kenilworth Primary Care LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Kenilworth Primary Care LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Kenilworth Primary Care LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 31D2040770) is associated with this NPI, valid through May 8, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Kenilworth Primary Care LLC was last updated on January 24, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kenilworth Primary Care Llc · NPI 1164793014
Primary Care organization in Kenilworth, New Jersey. Organization record, active in the CMS NPPES registry since January 24, 2012.
## Identity
- **NPI:** 1164793014 (Entity type: Organization)
- **Enumerated:** January 24, 2012
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Bhavani Jeereddy, SOLE MEMBER
## Practice location
- **Address:** 66 S 21ST ST, Kenilworth, NJ 07033-1626
- **Phone:** (908) 276-9595 · **Fax:** (908) 276-6807
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Internal Medicine) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 24, 2012
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1164793014) · Data from the CMS NPPES public registry.