NPIMap

Individual provider Active NPI

Anthony J Barravecchio, D.O.

  • Internal Medicine Physician
  • Wayne, NJ
National Provider Identifier
1114996477
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MB06978600 Issued in NJ
Practice address
510 Hamburg Tpke
Wayne Commons, Suite 101
Wayne, NJ 07470-2025
Phone
(973) 942-6005
Fax
(973) 942-6009
NPI assigned
Mar 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2013

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 25MB06978600 NJ Primary

Addresses

Primary practice location

510 Hamburg Tpke
Wayne Commons, Suite 101
Wayne, NJ 07470-2025

Mailing address

510 Hamburg Tpke
Wayne Commons, Suite 101
Wayne, NJ 07470-2025
Phone (973) 942-6005

Other identifiers 9

IdentifierTypeStateIssuer
7678228OtherNJAETNA PPO #
1K8291OtherNJHEALTHNET #
6R2921OtherNJEMPIRE BC/BS #
080180176OtherNJRAILROAD MDCR #
2016613000OtherNJAMERIHEALTH ID#
2586866OtherNJAETNA HMO #
8643903MedicaidNJ
5716972OtherNJGHI PPO #
P2010902OtherNJOXFORD ID#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050112001003 NJ Practitioner - Family Practice 1850362922 Reassigns benefits to 1 organization
I20240220000195 NY Practitioner - Family Practice 1850362922 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Haledon Medical, PCGroup PAC ID 0345299947, 11 clinicians

Practice addresses (Care Compare)

510 Hamburg Tpke
Suite 101
Wayne, NJ 07470-2033
Phone (973) 942-6005

Hospital & facility affiliations

  • Adoration Home Health Home health agency, Clifton, NJ, CCN 317017
  • Valley Home Care Inc. Home health agency, Paramus, NJ, CCN 317008
  • Chilton Medical Center Hospital, Pompton Plains, NJ, CCN 310017
  • St Joseph'S University Medical Center Inc Hospital, Paterson, NJ, CCN 310019
  • Valley Hospital Hospital, Paramus, NJ, CCN 310012
  • Lincoln Park Renaissance Nursing home, Lincoln Park, NJ, CCN 315042
  • Lincoln Park Care Center Nursing home, Lincoln Park, NJ, CCN 315249

Merit-based Incentive Payment System (MIPS)

Final score
82.88 of 100Reported as group
Quality
81.99
Promoting interoperability
95
Improvement activities
20
Cost
69.63

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MB06978600NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Allied Medical of Ny PC CurrentSince Dec 1, 2023 Accepting new patients
North Haledon Medical Past Accepting new patients
521 Pine Brook Operating, LLC Past Accepting new patients
World Chiropractic Incorporated Past Accepting new patients
Saddle Brook Medical Center PA Past Accepting new patients
Bergen Laparoscopic and General Surgery PA Past Accepting new patients

Locations

510 Hamburg Tpke
Ste 102
Wayne, NJ 07470
Phone (973) 595-7555

1 Old Country Rd
Ste 285
Carle Place, NY 11514
Phone (973) 942-6005

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lincoln Park RenaissanceLincoln Park, NJ, CCN 315042 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 1, 2013
Apr 1, 2013

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365033600000",
    "number": "1114996477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 HAMBURG TPKE",
            "address_2": "WAYNE COMMONS, SUITE 101",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702025",
            "telephone_number": "973-942-6005",
            "fax_number": "973-942-6009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 HAMBURG TPKE",
            "address_2": "WAYNE COMMONS, SUITE 101",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702025",
            "telephone_number": "973-942-6005",
            "fax_number": "973-942-6009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARRAVECCHIO",
        "first_name": "ANTHONY",
        "middle_name": "J",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2013-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MB06978600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO #",
            "identifier": "7678228",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET #",
            "identifier": "1K8291",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC/BS #",
            "identifier": "6R2921",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MDCR #",
            "identifier": "080180176",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH ID#",
            "identifier": "2016613000",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO #",
            "identifier": "2586866",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8643903",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI PPO #",
            "identifier": "5716972",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD ID#",
            "identifier": "P2010902",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, NJ

Sources for this page

Verify at the official NPI Registry.