NPIMap

Organization Active NPI

Stuart M Homer MD PA

  • Nephrology Physician
  • Avenel, NJ
National Provider Identifier
1124186010
Registry record updated Nov 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
STUART M HOMER MD PA
Practice address
1030 Saint Georges Ave
Suite 201
Avenel, NJ 07001-1390
Phone
(732) 602-0244
Fax
(732) 602-2577
NPI assigned
Dec 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2012

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

Authorized official

Name
Stuart M Homer, MDNPI 1760488373
Title
President
Phone
(732) 602-0244

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

1030 Saint Georges Ave
Suite 201
Avenel, NJ 07001-1390

Mailing address

1030 Saint Georges Ave
Suite 201
Avenel, NJ 07001-1390
Phone (732) 602-0244

Other identifiers 1

IdentifierTypeStateIssuer
0305529MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080917000571 NJ Part B Supplier - Clinic/Group Practice 3971556408 Receives reassigned benefits from 4 practitioners
Practice locations: Avenel, NJ

National Provider Directory

National Provider Directory

Locations

1030 Saint Georges Ave
Ste 201
Avenel, NJ 07001
Phone (732) 602-0244

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ABGIAA

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352764800000",
    "number": "1124186010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 SAINT GEORGES AVE",
            "address_2": "SUITE 201",
            "city": "AVENEL",
            "state": "NJ",
            "postal_code": "070011390",
            "telephone_number": "732-602-0244",
            "fax_number": "732-602-2577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 SAINT GEORGES AVE",
            "address_2": "SUITE 201",
            "city": "AVENEL",
            "state": "NJ",
            "postal_code": "070011390",
            "telephone_number": "732-602-0244",
            "fax_number": "732-602-2577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STUART M HOMER MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2012-11-13",
        "status": "A",
        "authorized_official_last_name": "HOMER",
        "authorized_official_first_name": "STUART",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-602-0244",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0305529",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Avenel, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.