K PRIMARY CARE AND MEDICAL NUTRITION CENTER
NPI 1477948362
Internal Medicine in New Providence, NJ
About K Primary Care And Medical Nutrition Center NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
K PRIMARY CARE AND MEDICAL NUTRITION CENTER (NPI 1477948362) is a healthcare organization registered as an internal medicine in New Providence, New Jersey and active in the NPI registry since March 2015. The organization holds a CLIA Waiver certificate valid through July 30, 2027 and lists Maureen Doherty, Credentialing Contact, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
K Primary Care And Medical Nutrition Center 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 K Primary Care And Medical Nutrition Center, 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 31D2099749
K Primary Care And Medical Nutrition Center, LLC · New Providence, 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 K Primary Care And Medical Nutrition Center's NPI number?
The NPI number for K Primary Care And Medical Nutrition Center is 1477948362. It was assigned to this organization in the NPPES registry on March 30, 2015.
Where is K Primary Care And Medical Nutrition Center located?
K Primary Care And Medical Nutrition Center is located at 571 Central Ave Suite 104, New Providence, NJ 07974. The listed phone number is (908) 206-4676.
What is K Primary Care And Medical Nutrition Center's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is K Primary Care And Medical Nutrition Center enrolled in Medicare?
Yes. K Primary Care And Medical Nutrition Center is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through K Primary Care And Medical Nutrition Center?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to K Primary Care And Medical Nutrition Center. 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 K Primary Care And Medical Nutrition Center hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 31D2099749) is associated with this NPI, valid through July 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for K Primary Care And Medical Nutrition Center was last updated on September 1, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.
# K Primary Care And Medical Nutrition Center · NPI 1477948362
Internal Medicine organization in New Providence, New Jersey. Organization record, active in the CMS NPPES registry since March 30, 2015.
## Identity
- **NPI:** 1477948362 (Entity type: Organization)
- **Enumerated:** March 30, 2015
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Organization subpart:** No
- **Authorized official:** Maureen Doherty, CREDENTIALING CONTACT
## Practice location
- **Address:** 571 CENTRAL AVE, SUITE 104, New Providence, NJ 07974-1547
- **Phone:** (908) 206-4676
## 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:** September 1, 2015
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1477948362) · Data from the CMS NPPES public registry.