Individual provider Active NPI

Madhuri Ponnaluri

  • Pediatric Nurse Practitioner
  • Newark, NJ
National Provider Identifier
1083387591
Registry record updated Mar 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
26NJ01197700 Issued in NJ
Practice address
741 Broadway
Newark, NJ 07104-4309
Phone
(973) 483-1300
Fax
(973) 676-1396
NPI assigned
Jul 29, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 26NJ01197700 NJ Primary

Addresses

Primary practice location

741 Broadway
Newark, NJ 07104-4309

Mailing address

741 Broadway
Newark, NJ 07104-4309
Phone (973) 483-1300

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211021001490 NJ Practitioner - Nurse Practitioner 2466840632 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physician Associates of North Jersey P C CurrentSince Nov 1, 2022 Accepting new patients
Barnabas Health Medical Group PC CurrentSince Dec 29, 2025 Accepting new patients
Newark Community Health Centers, Inc CurrentSince Nov 1, 2021 Accepting new patients
Rwjbh Primary Care Services Pediatrics CurrentSince Dec 29, 2025 Accepting new patients
Barnabas Health Medical Group PC CurrentSince Dec 29, 2025 Accepting new patients
Newark Community Health Centers, Inc. CurrentSince Nov 1, 2021 Accepting new patients
Mattoo Pediatrics PastSince Aug 1, 2021 Accepting new patients

Locations

355 Grand St
Jersey City, NJ 07302
Phone (201) 915-2224

475 Route 70
Ste 101
Lakewood, NJ 08701
Phone (732) 364-8000

94 Old Short Hills Rd
Livingston, NJ 07039
Phone (973) 322-5400

25 Kilmer Dr
Ste 107
Morganville, NJ 07751
Phone (732) 385-5262

741 Broadway
Newark, NJ 07104
Phone (973) 483-1300

99 Beauvoir Ave
Summit, NJ 07901
Phone (908) 522-2232

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

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HBFIAA

Organizations & group practices 7

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": "1627516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710374400000",
    "number": "1083387591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 BROADWAY",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071044309",
            "telephone_number": "973-483-1300",
            "fax_number": "973-676-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 BROADWAY",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071044309",
            "telephone_number": "973-483-1300",
            "fax_number": "973-676-1396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONNALURI",
        "first_name": "MADHURI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-29",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NJ",
            "license": "26NJ01197700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

Verify at the official NPI Registry.