Individual provider Active NPI

Marlyn Fernandez, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Glen Ridge, NJ
National Provider Identifier
1124253752
Registry record updated Jul 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
25MA09223600 Issued in NJ
Practice address
123 Highland Ave Ste 301
Glen Ridge, NJ 07028-1522
Phone
(973) 744-3733
Fax
(973) 707-5821
NPI assigned
May 27, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 25MA09223600 NJ Primary

Addresses

Primary practice location

123 Highland Ave Ste 301
Glen Ridge, NJ 07028-1522

Mailing address

PO Box 419430
Boston, MA 02241-9430
Phone (201) 967-8221

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140519001545 NJ Practitioner - Endocrinology 8325261472 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MPV New Jersey MD Services PCGroup PAC ID 5991097669, 146 clinicians

Practice addresses (Care Compare)

1 Bay Ave
Montclair, NJ 07042-4837
Phone (201) 781-1387

311 Bay Ave
Glen Ridge, NJ 07028-1607
Phone (973) 748-9246

622 Franklin Ave
Nutley, NJ 07110-1247
Phone (973) 661-1900

Hospital & facility affiliations

  • Hackensack Meridian Mountainside Medical Hospital, Montclair, NJ, CCN 310054

Merit-based Incentive Payment System (MIPS)

Final score
96.09 of 100Reported as apm
Quality
86.89
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA09223600NJMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Jul 1, 2016 Accepting new patients
MPV New Jersey MD Services PC CurrentSince Jul 15, 2019 Accepting new patients
MPV New Jersey MD Services PC CurrentSince Jul 15, 2019 Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Jul 1, 2016 Accepting new patients

Locations

452 Old Hook Rd
Fl 2
Emerson, NJ 07630
Phone (201) 599-1336

311 Bay Ave
Glen Ridge, NJ 07028
Phone (973) 748-9166

123 Highland Ave
Ste 301
Glen Ridge, NJ 07028
Phone (973) 744-3733

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

Interoperability endpoints

  • Direct secure messaging: mfernandez272786@ahs.direct-ci.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD

Organizations & group practices 4

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 1

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": "1243382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563148800000",
    "number": "1124253752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 419430",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022419430",
            "telephone_number": "201-967-8221",
            "fax_number": "201-483-2242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 HIGHLAND AVE STE 301",
            "city": "GLEN RIDGE",
            "state": "NJ",
            "postal_code": "070281522",
            "telephone_number": "973-744-3733",
            "fax_number": "973-707-5821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "MARLYN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-27",
        "last_updated": "2019-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NJ",
            "license": "25MA09223600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Ridge, NJ

Sources for this page

Verify at the official NPI Registry.