1. Home
  2. Directory
  3. New Jersey
  4. Neptune
  5. Family Medicine
  6. NPI Profile

KATHLEEN CARPIO DO
NPI 1538694963
Family Medicine - Adult Medicine in Neptune, NJ

Active since April 24, 2017PECOS EnrolledAccepts Medicare Assignment
93.71/100
CMS Quality Rating
3301 ROUTE 66 FL 1, NEPTUNE, NJ 07753(848) 217-2700 Get Directions Write a Review

NPPES record last updated: January 29, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jan 29, 2021, Nov 19, 2020, Aug 7, 2020 and 1 more (4 updates tracked since 2017).

About Kathleen Carpio Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KATHLEEN CARPIO DO (NPI 1538694963) is an individual adult medicine provider in Neptune, New Jersey, licensed in New Jersey (25MB10723100) and active in the NPI registry since April 2017. She is enrolled in Medicare PECOS, is affiliated with Jersey Shore University Medical Center, and is a graduate of Michigan State University College Of Osteopathic Medicine (2017).

NPPES Registry Identity

NPI1538694963
Entity TypeIndividualFemale
Primary Taxonomy207QA0505X
Provider Legal NameKATHLEEN CARPIOCredential: DO
Location Address3301 ROUTE 66 FL 1Neptune, NJ 07753-2705
Mailing Address1300 Highway 35 Unit 204Ocean, NJ 07712-3533 · (732) 531-6400 · Fax (732) 517-0223
Phone(848) 217-2700
Sole ProprietorYes
Medical School CMSMichigan State University College Of Osteopathic MedicineGraduated 2017
Enumeration DateApril 24, 2017
Last NPPES UpdateJanuary 29, 20214 updates tracked since enumeration
NPPES CertifiedJanuary 29, 2021
✔ NPI 1538694963 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Adult MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QA0505X
License✔ Licensed in NJ · 25MB10723100
Definition
The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.
3301 ROUTE 66 FL 1, Neptune, NJ 07753
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kathleen Carpio Do is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4688092851
PECOS Enrollment IDI20200921001214
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
111 services57 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
57 services57 patients
Annual depression screening, 5 to 15 minutes G0444
An annual depression screening is a short, routine evaluation to check for signs of depression. It involves answering a series of questions about your feelings, thoughts, and behaviors. The process takes about 15 minutes and helps detect depression early for better management.
56 services56 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
44 services33 patients
Telephone medical discussion with physician, 11-20 minutes 99442
This is a service where you have a phone conversation with your doctor for 11-20 minutes. It's used for discussing health concerns, reviewing test results, or managing ongoing conditions. It's a convenient way to receive medical advice without an in-person visit.
35 services28 patients
Telephone medical discussion with physician, 21-30 minutes 99443
This service involves a 21-30 minute phone conversation with a physician. It's a chance for you to discuss your health concerns, symptoms or treatment plans. It's similar to an in-person consultation, but conducted over the phone for your convenience and safety.
17 services16 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Jersey Shore University Medical Center

Acute Care Hospitals · Neptune, NJ
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number310073
Location1945 State Route 33Neptune, NJ 07753 · Monmouth County
Emergency services Birthing friendly

Monmouth Medical Center

Acute Care Hospitals · Long Branch, NJ
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number310075
Location300 Second AvenueLong Branch, NJ 07740 · Monmouth County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 07753 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$94.90 typical visit price
range $61.59 – $185.05
Typical copayment $23.72 (range $15.39 – $46.26)
Most-billed visit code 99203
Established Patient
$107.94 typical visit price
range $20.08 – $150.98
Typical copayment $26.98 (range $5.02 – $37.74)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

93.71/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality77.79
Promoting Interoperability100
Improvement Activities40

Frequently 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 Kathleen Carpio's NPI number?

The NPI number for Kathleen Carpio is 1538694963. It was assigned to this individual provider in the NPPES registry on April 24, 2017.

Where is Kathleen Carpio located?

Kathleen Carpio practices at 3301 Route 66 Fl 1, Neptune, NJ 07753. The listed phone number is (848) 217-2700.

What is Kathleen Carpio's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

Is Kathleen Carpio enrolled in Medicare?

Yes. Kathleen Carpio is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Kathleen Carpio accept?

Health plans from Ambetter Health and Ambetter Health of Delaware list Kathleen Carpio as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Kathleen Carpio affiliated with any hospitals?

According to CMS data, Kathleen Carpio is affiliated with Jersey Shore University Medical Center and Monmouth Medical Center.

When was this NPI record last updated?

The NPPES record for Kathleen Carpio was last updated on January 29, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.