NPIMap

Organization Active NPI

Ccmma NJ LLC

  • Critical Care Medicine (Anesthesiology) Physician
  • Passaic, NJ
National Provider Identifier
1124543095
Registry record updated Oct 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Anesthesiology) PhysicianTaxonomy code 207LC0200X
Legal business name
CCMMA NJ LLC
Practice address
350 Boulevard
Passaic, NJ 07055-2840
Phone
(973) 365-4300
NPI assigned
Aug 11, 2017
Last updated
Oct 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2022

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

Authorized official

Name
Laurie Laduca
Title
Manager
Phone
(845) 702-2711

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LC0200X Primary
Critical Care Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0200X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X

Addresses

Primary practice location

350 Boulevard
Passaic, NJ 07055-2840

Mailing address

PO Box 631800
Cincinnati, OH 45263-1800
Phone (845) 702-2711

Other practice location 1

425 Newburgh Ct
West New York, NJ 07093-8340
Phone (845) 702-2711

Other practice location 2

100 Medical Center Way
Somers Point, NJ 08244-2300
Phone (609) 653-3500

Other practice location 3

224 W 18th St Apt 8A
New York, NY 10011-4558
Phone (914) 523-2189

Other practice location 4

24 Beachmont Ter
Caldwell, NJ 07006-4544
Phone (845) 702-2711

Other practice location 5

6565 Fannin St
Houston, TX 77030-2703
Phone (713) 790-3311

Other practice location 6

1 Messenger Dr
Colts Neck, NJ 07722-2124
Phone (845) 702-2711

Other practice location 7

10 Kristen Ct
Somerset, NJ 08873-5048
Phone (845) 702-2711

Other practice location 8

1315 Marlkress Rd
Cherry Hill, NJ 08003-2625
Phone (845) 702-2711

Other practice location 9

111 Central Ave
Newark, NJ 07102-1909
Phone (973) 877-5000

Other practice location 10

50 Brown Cir
Paramus, NJ 07652-5204
Phone (845) 702-2711

Other practice location 11

29 Garden Pl
Westwood, NJ 07675-1503
Phone (845) 702-2711

Other practice location 12

285 Aycrigg Ave
Passaic, NJ 07055-3737
Phone (845) 702-2711

Other practice location 13

120 N Delaware St
Sandusky, MI 48471-1009
Phone (810) 648-3770

Other practice location 14

201 NW R D Mize Rd
Blue Springs, MO 64014-2513
Phone (816) 228-5900

Other practice location 15

425 W 5th St
East Liverpool, OH 43920-2498
Phone (330) 385-7200

Other practice location 16

600 S Monroe St
Enid, OK 73701-7211
Phone (580) 233-2300

Other practice location 17

129 N Washington St
Sumter, SC 29150-4949
Phone (803) 774-9000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170926000361 NJ Part B Supplier - Clinic/Group Practice 8123392495 Receives reassigned benefits from 54 practitioners
Practice locations: Paramus, NJ; Dover, NJ; Passaic, NJ; Princeton, NJ; Roseland, NJ; Somers Point, NJ; Somerset, NJ; Totowa, NJ…
O20230309001767 PA Part B Supplier - Clinic/Group Practice 8123392495 Receives reassigned benefits from 2 practitioners
Practice locations: Sayre, PA; Towanda, PA; Troy, PA

National Provider Directory

National Provider Directory

Locations

16088 San Pedro Ave
Ste 101
San Antonio, TX 78232

25615 US Highway 281 N
Ste 100
San Antonio, TX 78258

16977 Interstate 35 N
Ste 100
Schertz, TX 78154

Practitioners & affiliated clinicians

Practitioners 74

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 74

NPI Registry JSON

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

{
    "created_epoch": "1502409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665705600000",
    "number": "1124543095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 631800",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452631800",
            "telephone_number": "845-702-2711",
            "fax_number": "888-220-6560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 BOULEVARD",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070552840",
            "telephone_number": "973-365-4300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "425 Newburgh Ct",
            "address_purpose": "LOCATION",
            "city": "West New York",
            "state": "NJ",
            "postal_code": "070938340",
            "country_code": "US",
            "telephone_number": "845-702-2711",
            "fax_number": "888-220-6560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Medical Center Way",
            "address_purpose": "LOCATION",
            "city": "Somers Point",
            "state": "NJ",
            "postal_code": "082442300",
            "country_code": "US",
            "telephone_number": "609-653-3500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "224 W 18th St Apt 8A",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100114558",
            "country_code": "US",
            "telephone_number": "914-523-2189",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24 Beachmont Ter",
            "address_purpose": "LOCATION",
            "city": "Caldwell",
            "state": "NJ",
            "postal_code": "070064544",
            "country_code": "US",
            "telephone_number": "845-702-2711",
            "fax_number": "888-220-6560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6565 Fannin St",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770302703",
            "country_code": "US",
            "telephone_number": "713-790-3311",
            "fax_number": "888-220-6560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Messenger Dr",
            "address_purpose": "LOCATION",
            "city": "Colts Neck",
            "state": "NJ",
            "postal_code": "077222124",
            "country_code": "US",
            "telephone_number": "845-702-2711",
            "fax_number": "888-220-6560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10 Kristen Ct",
            "address_purpose": "LOCATION",
            "city": "Somerset",
            "state": "NJ",
            "postal_code": "088735048",
            "country_code": "US",
            "telephone_number": "845-702-2711",
            "fax_number": "888-220-6560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1315 Marlkress Rd",
            "address_purpose": "LOCATION",
            "city": "Cherry Hill",
            "state": "NJ",
            "postal_code": "080032625",
            "country_code": "US",
            "telephone_number": "845-702-2711",
            "fax_number": "888-220-6560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Newark",
            "state": "NJ",
            "postal_code": "071021909",
            "country_code": "US",
            "telephone_number": "973-877-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "50 Brown Cir",
            "address_purpose": "LOCATION",
            "city": "Paramus",
            "state": "NJ",
            "postal_code": "076525204",
            "country_code": "US",
            "telephone_number": "845-702-2711",
            "fax_number": "888-220-6560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "29 Garden Pl",
            "address_purpose": "LOCATION",
            "city": "Westwood",
            "state": "NJ",
            "postal_code": "076751503",
            "country_code": "US",
            "telephone_number": "845-702-2711",
            "fax_number": "888-220-6560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "285 Aycrigg Ave",
            "address_purpose": "LOCATION",
            "city": "Passaic",
            "state": "NJ",
            "postal_code": "070553737",
            "country_code": "US",
            "telephone_number": "845-702-2711",
            "fax_number": "888-220-6560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 N Delaware St",
            "address_purpose": "LOCATION",
            "city": "Sandusky",
            "state": "MI",
            "postal_code": "484711009",
            "country_code": "US",
            "telephone_number": "810-648-3770",
            "fax_number": "888-220-6560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 NW R D Mize Rd",
            "address_purpose": "LOCATION",
            "city": "Blue Springs",
            "state": "MO",
            "postal_code": "640142513",
            "country_code": "US",
            "telephone_number": "816-228-5900",
            "fax_number": "888-220-6560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "425 W 5th St",
            "address_purpose": "LOCATION",
            "city": "East Liverpool",
            "state": "OH",
            "postal_code": "439202498",
            "country_code": "US",
            "telephone_number": "330-385-7200",
            "fax_number": "888-220-6560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 S Monroe St",
            "address_purpose": "LOCATION",
            "city": "Enid",
            "state": "OK",
            "postal_code": "737017211",
            "country_code": "US",
            "telephone_number": "580-233-2300",
            "fax_number": "888-220-6560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "129 N Washington St",
            "address_purpose": "LOCATION",
            "city": "Sumter",
            "state": "SC",
            "postal_code": "291504949",
            "country_code": "US",
            "telephone_number": "803-774-9000",
            "fax_number": "888-220-6560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CCMMA NJ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-11",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "LADUCA",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "845-702-2711"
    },
    "taxonomies": [
        {
            "code": "207LC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Passaic, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; 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.