NPIMap

Individual provider Active NPI

Crisnoel Cervantes, M.D.

  • Internal Medicine Physician
  • Whiting, NJ
National Provider Identifier
1043211840
Registry record updated Jul 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA06235700 Issued in NJ
Practice address
65 Lacey Rd
Suite a
Whiting, NJ 08759-2985
Phone
(732) 350-0404
Fax
(732) 350-2001
NPI assigned
Aug 3, 2005
Last updated
Jul 3, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA06235700 NJ Primary

Addresses

Primary practice location

65 Lacey Rd
Suite a
Whiting, NJ 08759-2985

Mailing address

65 Lacey Rd
Suite a
Whiting, NJ 08759-2985
Phone (732) 350-0404

Other identifiers 1

IdentifierTypeStateIssuer
6682901MedicaidNJ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050711000112 NJ Practitioner - Internal Medicine 2860428141 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rwjbh Primary Care ServicesGroup PAC ID 0749699346, 266 clinicians

Practice addresses (Care Compare)

65 Lacey Rd
Suite a
Whiting, NJ 08759-2985
Phone (732) 350-0404

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rwjbh Primary Care Services Internal Medicine CurrentSince Oct 2, 2021 Accepting new patients
Barnabas Health Medical Group, PC Internal Medicine CurrentSince Aug 1, 2015 Accepting new patients
Community Medical Center Inc Past Accepting new patients

Locations

166 Lyons Ave
Newark, NJ 07112
Phone (973) 926-7300

766 Shrewsbury Ave
Ste 100
Tinton Falls, NJ 07724
Phone (732) 945-2009

8 Mountain Blvd
Ste J
Warren, NJ 07059
Phone (732) 893-0200

223 Monmouth Rd
West Long Branch, NJ 07764
Phone (732) 229-3838

65 Lacey Rd
Ste A
Whiting, NJ 08759
Phone (732) 350-0404

Interoperability endpoints

  • Direct secure messaging: ccervantes@direct.rwjbh.org
  • Direct secure messaging: ccervantes45833@epicdirect.rwjbh.org

Organizations & group practices 3

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 6

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": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341273600000",
    "number": "1043211840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 LACEY RD",
            "address_2": "SUITE A",
            "city": "WHITING",
            "state": "NJ",
            "postal_code": "087592985",
            "telephone_number": "732-350-0404",
            "fax_number": "732-350-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 LACEY RD",
            "address_2": "SUITE A",
            "city": "WHITING",
            "state": "NJ",
            "postal_code": "087592985",
            "telephone_number": "732-350-0404",
            "fax_number": "732-350-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CERVANTES",
        "first_name": "CRISNOEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-03",
        "last_updated": "2012-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA06235700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6682901",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whiting, NJ

Sources for this page

Verify at the official NPI Registry.