NPIMap

Organization Active NPI

Visiting Nurse Association of Central Jersey Community Health Center I

  • Federally Qualified Health Center (FQHC)
  • Keyport, NJ
National Provider Identifier
1003867250
Registry record updated Jul 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
82448 Issued in NJ
Legal business name
VISITING NURSE ASSOCIATION OF CENTRAL JERSEY COMMUNITY HEALTH CENTER I
Practice address
35 Broad Street
Keyport, NJ 07735
Phone
(732) 888-4149
Fax
(732) 264-0799
NPI assigned
May 12, 2006
Last updated
Jul 29, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2026

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

Authorized official

Name
Jessica Perez
Title
Credentialing Contact
Phone
(732) 776-3915

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 82448 NJ Primary

Addresses

Primary practice location

35 Broad Street
Keyport, NJ 07735

Mailing address

1301 Main St
Asbury Park, NJ 07712-5359
Phone (732) 888-4149

Other identifiers 1

IdentifierTypeStateIssuer
0002429MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040107000585 NJ Part B Supplier - Clinic/Group Practice 1456250679 Receives reassigned benefits from 91 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Asbury Park, NJ; Freehold, NJ; Keyport, NJ; Red Bank, NJ
O20040305000176 NJ Part A Provider - Federally Qualified Health Center (FQHC) 1456250679 Practice locations: Keyport, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003867250. Details of each certification follow.

Federally qualified health center certification: CCN 311841

Legal name
VISITING NURSE ASSOCIATION OF CENTRAL JERSEY COMMUNITY HEALTH CENTER I
Doing business as
KEYPORT PRIMARY CARE CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 21, 2004
Last certification
Apr 21, 2004
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jul 15, 1994 in NJ
Enrollment address
35 Broad St
Keyport, NJ 77351267

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Visiting Nurse Assn5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kevin Gerard Rogers Individual Corporate OfficerChief Financial Officer Jan 1, 2021
Jessica Perez Individual W-2 Managing Employee Jun 6, 2016
Anthony Previtera Individual Corporate DirectorBoard Member Apr 21, 2020
John Thomas Zim Individual Corporate DirectorFinancial Controller Jun 19, 2023
W-2 Managing EmployeeFinancial Controller Jun 19, 2023
Christopher Rinn Individual Corporate DirectorCeo Nov 1, 2018
Debra Giordano Individual Corporate DirectorBoard President Mar 1, 2006
Thomas Thees Individual Corporate DirectorBoard Member Apr 21, 2020
Beatriz Oesterheld Individual Corporate DirectorBoard Member Oct 22, 2012
Liza Dejesus Individual Corporate DirectorBoard Member Mar 21, 2012
Ian Brett Leber Individual Corporate OfficerChief Medical Officer Jul 1, 2023
W-2 Managing EmployeeChief Medical Officer Jul 1, 2023
Jenna Vaccaro-Kolarsick Individual Corporate Director Apr 21, 2020
Mostafa Hefni Individual Corporate DirectorBoard Member Apr 21, 2020
Lynn Miller Individual Corporate DirectorBoard Member Jul 26, 2010
Gail G Reilly Individual Corporate OfficerCcqo Aug 29, 2016
Art Gallagher Individual Corporate DirectorBoard Member Apr 21, 2020
Jeanne Koller Individual Corporate DirectorBoard Member Apr 21, 2020
Olubukunola Oyedele Individual Corporate DirectorBoard Member Apr 21, 2020
Robert Serbe Individual Corporate DirectorBoard Member Apr 21, 2020

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785283200000",
    "number": "1003867250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 MAIN ST",
            "city": "ASBURY PARK",
            "state": "NJ",
            "postal_code": "077125359",
            "telephone_number": "732-888-4149",
            "fax_number": "732-264-0799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 BROAD STREET",
            "city": "KEYPORT",
            "state": "NJ",
            "postal_code": "07735",
            "telephone_number": "732-888-4149",
            "fax_number": "732-264-0799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISITING NURSE ASSOCIATION OF CENTRAL JERSEY COMMUNITY HEALTH CENTER I",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CREDENTIALING CONTACT",
        "authorized_official_telephone_number": "732-776-3915"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NJ",
            "license": "82448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0002429",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Keyport, NJ

Sources for this page

Verify at the official NPI Registry.