NPIMap

Individual provider Active NPI

Raed A Jitan, M.D.

  • Cardiovascular Disease Physician
  • Holmdel, NJ
National Provider Identifier
1033167986
Registry record updated Jan 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
84811 Issued in OH
Practice address
15 McCampbell Rd
Holmdel, NJ 07733-2291
Phone
(732) 946-0995
Fax
(732) 946-0995
NPI assigned
May 4, 2006
Last updated
Jan 19, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2012

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 25MA07843100 NJ
Cardiovascular Disease Physician 207RC0000X 17922 WV
Cardiovascular Disease Physician 207RC0000X 31939 KY
Cardiovascular Disease Physician 207RC0000X 84811 OH Primary
Cardiovascular Disease Physician 207RC0000X 20531 SC
Cardiovascular Disease Physician 207RC0000X 23877 AL
Cardiovascular Disease Physician 207RC0000X 29166 IA

Addresses

Primary practice location

15 McCampbell Rd
Holmdel, NJ 07733-2291

Mailing address

15 McCampbell Rd
Holmdel, NJ 07733-2291
Phone (732) 946-0995

Other identifiers 3

IdentifierTypeStateIssuer
0176401MedicaidOH
0078319000MedicaidWV
64319395MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
23877ALMDCardiovascular Disease Physician
29166IAMDCardiovascular Disease Physician
31939KYMDCardiovascular Disease Physician
84811OHMDCardiovascular Disease Physician
17922WVMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ultimate Health Services, Inc. Past Accepting new patients
St. Mary's Himg, LLC Past Accepting new patients
Foothills Cardiology Associates PA Cardiovascular Disease Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Ultimate Health Services Inc Cardiovascular Disease Past Accepting new patients
Cannon Memorial Hospital Past Accepting new patients
Heartbeat Medical PC Cardiovascular Disease PastSince Jun 14, 2014 Accepting new patients
Medical Health Center, P.a. Cardiovascular Disease Past Accepting new patients

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326931200000",
    "number": "1033167986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 MCCAMPBELL RD",
            "city": "HOLMDEL",
            "state": "NJ",
            "postal_code": "077332291",
            "telephone_number": "732-946-0995",
            "fax_number": "732-946-0995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 MCCAMPBELL RD",
            "city": "HOLMDEL",
            "state": "NJ",
            "postal_code": "077332291",
            "telephone_number": "732-946-0995",
            "fax_number": "732-946-0995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JITAN",
        "first_name": "RAED",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2012-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NJ",
            "license": "25MA07843100",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WV",
            "license": "17922",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "KY",
            "license": "31939",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "84811",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "SC",
            "license": "20531",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AL",
            "license": "23877",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IA",
            "license": "29166",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0176401",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0078319000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64319395",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Holmdel, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.