NPIMap

Individual provider Active NPI

Mamatha Reddy Gadarla, M.D.

  • Internal Medicine Physician
  • Caldwell, NJ
National Provider Identifier
1124167879
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA08121700 Issued in NJ
Practice address
526 Bloomfield Ave Ste 103
Caldwell, NJ 07006-5525
Phone
(973) 239-1600
Fax
(973) 559-6188
NPI assigned
Feb 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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 25MA08121700 NJ Primary

Addresses

Primary practice location

526 Bloomfield Ave Ste 103
Caldwell, NJ 07006-5525

Mailing address

105 Jesse Court
Montville, NJ 07045-3459
Phone (973) 265-8729

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
I20071112000529 NJ Practitioner - Internal Medicine 1052419686 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Passaic Hospitalist Services, LLCGroup PAC ID 8426404484, 30 clinicians

Practice addresses (Care Compare)

526 Bloomfield Ave
Suite 103
Caldwell, NJ 07006-5525
Phone (973) 239-1600

703 Main St
Paterson, NJ 07503-2621
Phone (973) 754-2000

Hospital & facility affiliations

  • Hospice of New Jersey, LLC Hospice, Bloomfield, NJ, CCN 311540
  • Grace Healthcare Services LLC Hospice, Edison, NJ, CCN 311563
  • St Joseph'S University Medical Center Inc Hospital, Paterson, NJ, CCN 310019
  • Complete Care at St Vincents LLC Nursing home, Cedar Grove, NJ, CCN 315194
  • Complete Care at West Caldwell LLC Nursing home, West Caldwell, NJ, CCN 315247

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA08121700NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Essex Primary Care PC Internal Medicine CurrentSince May 23, 2015 Accepting new patients
St Josephs Medical Group PC Internal Medicine CurrentSince Nov 2, 2021 Accepting new patients
Passaic Hospitalist Services, LLC CurrentSince Feb 24, 2024 Accepting new patients
St. Joseph'S Healthcare, Inc. Internal Medicine CurrentSince Jul 16, 2018 Accepting new patients
Regional Physician Services, NJ, PC Internal Medicine Past Accepting new patients

Locations

526 Bloomfield Ave
Ste 103
Caldwell, NJ 07006
Phone (973) 226-0559

703 Main St
Rm XG2126
Paterson, NJ 07503
Phone (973) 754-2240

703 Main St
#G
Paterson, NJ 07503
Phone (973) 754-6331

703 Main St
Paterson, NJ 07503
Phone (973) 754-2240

97 W Parkway
Pompton Plns, NJ 07444
Phone (973) 831-5000

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
Complete Care at St Vincents LLCCedar Grove, NJ, CCN 315194 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 1, 2024
Feb 1, 2024

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 5

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 5

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": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1124167879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 JESSE COURT",
            "city": "MONTVILLE",
            "state": "NJ",
            "postal_code": "070453459",
            "telephone_number": "973-265-8729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 BLOOMFIELD AVE STE 103",
            "city": "CALDWELL",
            "state": "NJ",
            "postal_code": "070065525",
            "telephone_number": "973-239-1600",
            "fax_number": "973-559-6188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GADARLA",
        "first_name": "MAMATHA",
        "middle_name": "REDDY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-06",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA08121700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Caldwell, NJ

Sources for this page

Verify at the official NPI Registry.