Individual provider Active NPI

Elise Butkiewicz, MD

  • Family Medicine Physician
  • Summit, NJ
National Provider Identifier
1023196979
Registry record updated Sep 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MA06301400 Issued in NJ
Practice address
33 Overlook Rd
103
Summit, NJ 07901-3570
Phone
(908) 522-5700
NPI assigned
Nov 1, 2006
Last updated
Sep 4, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25MA06301400 NJ Primary

Addresses

Primary practice location

33 Overlook Rd
103
Summit, NJ 07901-3570

Mailing address

PO Box 416457
Boston, MA 02241-6457

Other identifiers 2

IdentifierTypeStateIssuer
7297904MedicaidNJ
953197N2ZOtherNJBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050714000202 NJ Practitioner - Family Practice 4789610403 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rutgers New Jersey Medical School, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Practice Associates Medical GroupGroup PAC ID 5890703177, 1,412 clinicians

Practice addresses (Care Compare)

100 Madison Ave
Morristown, NJ 07960-6136
Phone (973) 971-5596

33 Overlook Rd
L01
Summit, NJ 07901-3561
Phone (908) 522-5700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Practice Associates Medical Group Family Medicine CurrentSince Sep 10, 2012 Accepting new patients
Ahs Hospital Corp. Past Accepting new patients

Locations

100 Madison Ave
Morristown, NJ 07960
Phone (973) 538-5210

465 South St
Ste 103
Morristown, NJ 07960
Phone (973) 971-7130

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378252800000",
    "number": "1023196979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 416457",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022416457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 OVERLOOK RD",
            "address_2": "103",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079013570",
            "telephone_number": "908-522-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTKIEWICZ",
        "first_name": "ELISE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2013-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA06301400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7297904",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "953197N2Z",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Summit, NJ

Sources for this page

Verify at the official NPI Registry.