NPIMap

Individual provider Active NPI

Sanjay Kavathia, M.D.

  • Internal Medicine Physician
  • Hackettstown, NJ
National Provider Identifier
1124078142
Registry record updated Feb 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA07267000 Issued in NJ
Practice address
616 Willow Grove St
Unit 1a
Hackettstown, NJ 07840-1779
Phone
(908) 852-8484
Fax
(908) 852-4197
NPI assigned
May 11, 2006
Last updated
Feb 5, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 5, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MA072670 NJ
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 25MA07267000 NJ Primary

Addresses

Primary practice location

616 Willow Grove St
Unit 1a
Hackettstown, NJ 07840-1779

Mailing address

616 Willow Grove St
Unit 1a
Hackettstown, NJ 07840-1779
Phone (908) 852-8484

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
I20050105000072 NJ Practitioner - Internal Medicine 1557329984 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

616 Willow Grove St
Unit 1a
Hackettstown, NJ 07840-1779
Phone (908) 852-8484

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA07267000NJMDInternal Medicine Physician
MA072670NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primed Medical Care PC Single Specialty CurrentSince Dec 8, 2004 Accepting new patients
Forest Manor Management, LLC Past Accepting new patients

Locations

616 Willow Grove St
Ste 1
Hackettstown, NJ 07840

616 Willow Grove St
Ste 1A
Hackettstown, NJ 07840
Phone (908) 852-8484

616 Willow Grove St
Unit 1A
Hackettstown, NJ 07840
Phone (908) 852-8484

653 Willow Grove St
Ste 2500
Hackettstown, NJ 07840
Phone (908) 852-8484

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DCBFBA/Endpoint/DCBFBA
  • Direct secure messaging: sanjay.kavathia@pmca.eclinicaldirectplus.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423094400000",
    "number": "1124078142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 WILLOW GROVE ST",
            "address_2": "UNIT 1A",
            "city": "HACKETTSTOWN",
            "state": "NJ",
            "postal_code": "078401779",
            "telephone_number": "908-852-8484",
            "fax_number": "908-852-4197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 WILLOW GROVE ST",
            "address_2": "UNIT 1A",
            "city": "HACKETTSTOWN",
            "state": "NJ",
            "postal_code": "078401779",
            "telephone_number": "908-852-8484",
            "fax_number": "908-852-4197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAVATHIA",
        "first_name": "SANJAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2015-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MA072670",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA07267000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackettstown, NJ

Sources for this page

Verify at the official NPI Registry.