Individual provider Active NPI

Suman Jain, M.D.

  • Pediatrics Physician
  • Lakewood, NJ
National Provider Identifier
1114027109
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MA58443 Issued in NJ
Practice address
101 Prospect St
Lakewood, NJ 08701-5020
Phone
(732) 363-1424
Fax
(732) 370-0714
NPI assigned
Sep 22, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MA58443 NJ Primary

Addresses

Primary practice location

101 Prospect St
Lakewood, NJ 08701-5020

Mailing address

1366 Vincenzo Dr
Toms River, NJ 08753-2768
Phone (732) 286-5295

Other identifiers 1

IdentifierTypeStateIssuer
5323 908MedicaidNJ

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
I20160902001031 NJ Practitioner - Pediatric Medicine 1456647254 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA58443NJMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hackensack Meridian Health Medical Group - Primary Care PC Pediatrics CurrentSince Jul 11, 2016 Accepting new patients
Lakewood Pediatric Associates Pediatrics PastSince Jul 11, 2016 Accepting new patients

Locations

985 Cedar Bridge Ave
Brick, NJ 08723
Phone (732) 477-5600

101 Prospect St
Ste 112
Lakewood, NJ 08701
Phone (732) 363-1424

500 US Highway 9
Lanoka Harbor, NJ 08734
Phone (609) 693-8131

Interoperability endpoints

  • FHIR API: https://mepic.hmhn.org/fhir/api/FHIR/R4/
  • Direct secure messaging: suman.jain@direct.hackensackmeridian.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114027109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1366 VINCENZO DR",
            "city": "TOMS RIVER",
            "state": "NJ",
            "postal_code": "087532768",
            "telephone_number": "732-286-5295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PROSPECT ST",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015020",
            "telephone_number": "732-363-1424",
            "fax_number": "732-370-0714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAIN",
        "first_name": "SUMAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "MA58443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5323 908",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, NJ

Sources for this page

Verify at the official NPI Registry.