Bassam N Odatalla, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

08610800 Issued in NJ

Practice address

200 Fairfield Rd
Fairfield, NJ 07004-2426

Phone

(973) 487-1944

Fax

(973) 487-1945

NPI assigned

May 21, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Family Practice

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hackensack Meridian Urgent Care PCGroup PAC ID 2769751270, 50 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: hackensackmeridian.bassamodatalla@136290.advancedmd-direct.com

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

• Hackensack Meridian Urgent Care, PC

  • Urgent Care Clinic/Center
  • Freehold, NJ
  • NPI 1285165209
  Medicare reassignment Care Compare group NPD
• Browne Medical, LLC

  • Urgent Care Clinic/Center
  • South Plainfield, NJ
  • NPI 1851733349
  Medicare reassignment NPD
• Doctor'S Office of West Caldwell LLC

  • Urgent Care Clinic/Center
  • West Caldwell, NJ
  • NPI 1144524786
  Medicare reassignment NPD
• Doctors Office of Brick

  • Urgent Care Clinic/Center
  • Brick, NJ
  • NPI 1184067944
  Medicare reassignment NPD
• Doctors Office of New Jersey, LLC

  • Urgent Care Clinic/Center
  • Midland Park, NJ
  • NPI 1508264177
  Medicare reassignment NPD
• DRX Paramus, LLC

  • Urgent Care Clinic/Center
  • Paramus, NJ
  • NPI 1316272685
  Medicare reassignment NPD
• Excel Urgent Care of NJ LLC

  • Urgent Care Clinic/Center
  • Old Bridge, NJ
  • NPI 1255742243
  Medicare reassignment NPD
• Excel Urgent Care of Paramus LLC

  • Internal Medicine Physician
  • Paramus, NJ
  • NPI 1063652220
  Medicare reassignment NPD
• Jersey Irish Medical

  • Urgent Care Clinic/Center
  • Bound Brook, NJ
  • NPI 1144575739

  Family Medicine

  Medicare reassignment NPD
• The Radiology Group of New Jersey, LLC

  • Multi-Specialty Clinic/Center
  • Hackettstown, NJ
  • NPI 1174010540
  NPD (past)
• William K Lee MD PA

  • Cardiovascular Disease Physician
  • Oakland, NJ
  • NPI 1508891003
  NPD (past)
• Northern Ohio Medical Specialists, LLC

  • Radiology Clinic/Center
  • Sheffield Village, OH
  • NPI 1508811332
  NPD (past)

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439942400000",
    "number": "1063620060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 FAIRFIELD RD",
            "city": "FAIRFIELD",
            "state": "NJ",
            "postal_code": "070042426",
            "telephone_number": "973-487-1944",
            "fax_number": "973-487-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 FAIRFIELD RD",
            "city": "FAIRFIELD",
            "state": "NJ",
            "postal_code": "070042426",
            "telephone_number": "973-487-1944",
            "fax_number": "973-487-1945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODATALLA",
        "first_name": "BASSAM",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-21",
        "last_updated": "2015-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "08610800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nowlab LLC
• Elliot Y. Nussbaum, PHARM D.
• Nutrition Transition LLC
• Megan O'Brien
• Jeffrey N Obiekwe
• Nada Omran, PA-C
• Carlo Opont, PA-C
• Chiamaka Chikwere Orjiekwe, PHARM D
• Daniel Paolino
• Jennifer Mary Paonessa, OTR/L

• Family Medicine Physician in Fairfield, NJ
• Providers in Fairfield, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.