NPIMap

Individual provider Active NPI

Jean C Pattathil, MD

  • Internal Medicine Physician
  • Elizabeth, NJ
National Provider Identifier
1124103874
Registry record updated Sep 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA07295500 Issued in NJ
Practice address
240 Williamson St
Suite 204
Elizabeth, NJ 07202
Phone
(908) 355-8877
Fax
(908) 355-0017
NPI assigned
Oct 25, 2006
Last updated
Sep 11, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2014

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 25MA07295500 NJ Primary

Addresses

Primary practice location

240 Williamson St
Suite 204
Elizabeth, NJ 07202

Mailing address

240 Williamson St
Suite 204
Elizabeth, NJ 07202
Phone (908) 355-8877

Other identifiers 1

IdentifierTypeStateIssuer
9065806MedicaidNJ

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
I20050304000304 NJ Practitioner - Internal Medicine 9133173966 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
NJ Med, PAGroup PAC ID 4385779818, 6 clinicians

Practice addresses (Care Compare)

240 Williamson St
Suite 204
Elizabeth, NJ 07202-3671
Phone (908) 355-8877

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
NJ Med, PA Internal Medicine CurrentSince Aug 1, 2002 Accepting new patients

Locations

240 Williamson St
Ste 204
Elizabeth, NJ 07202
Phone (908) 355-8877

Organizations & group practices 1

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 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": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410393600000",
    "number": "1124103874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 WILLIAMSON ST",
            "address_2": "SUITE 204",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "07202",
            "telephone_number": "908-355-8877",
            "fax_number": "908-355-0017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 WILLIAMSON ST",
            "address_2": "SUITE 204",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "07202",
            "telephone_number": "908-355-8877",
            "fax_number": "908-355-0017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATTATHIL",
        "first_name": "JEAN",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2014-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA07295500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9065806",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth, NJ

Sources for this page

Verify at the official NPI Registry.