Victory Medical Clinic LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA08035200 Issued in NJ

Legal business name

VICTORY MEDICAL CLINIC LLC

Practice address

433 Sand Shore Rd
Hackettstown, NJ 07840-5504

Phone

(862) 254-2299

Fax

(862) 254-2300

NPI assigned

Jun 16, 2016

Organization subpart

No

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

Authorized official

Name

Augustine Okpala, MDNPI 1124085766

Title

Healthcare Professional

Phone

(862) 254-2299

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14300/brand/1/csg/1/fhir/r4

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Augustine Chukwujekwu Okpala, M.D

  • Internal Medicine Physician
  • Newton, NJ
  • NPI 1124085766
  Medicare reassignment Care Compare group Authorized official
• Nkemamaka Chinenyenwa Okpala, MD

  • Internal Medicine Physician
  • Hackettstown, NJ
  • NPI 1992062749
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466035200000",
    "number": "1013367465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 SAND SHORE RD",
            "city": "HACKETTSTOWN",
            "state": "NJ",
            "postal_code": "078405504",
            "telephone_number": "862-254-2299",
            "fax_number": "862-254-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 SAND SHORE RD",
            "city": "HACKETTSTOWN",
            "state": "NJ",
            "postal_code": "078405504",
            "telephone_number": "862-254-2299",
            "fax_number": "862-254-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-16",
        "last_updated": "2016-06-16",
        "status": "A",
        "authorized_official_last_name": "OKPALA",
        "authorized_official_first_name": "AUGUSTINE",
        "authorized_official_title_or_position": "HEALTHCARE PROFESSIONAL",
        "authorized_official_telephone_number": "862-254-2299",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA08035200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Vander Vliet, DMD
• Kristina M. Vander, LCSW
• Reah-Gayle Vargas
• Jude E Velez, PT
• Victory Care Givers LLC
• Christopher Mark Viggiano, D.C.
• Village Family Clinic, LLC
• Village Family Medical
• Marc H Vilmenay, RRT, CPFT
• Diana Violante

• Internal Medicine Physician in Hackettstown, NJ
• Providers in Hackettstown, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.