Active NPI
Jean A Otrakji, M.D.
- Nephrology Physician
- Holmdel, NJ
National Provider Identifier
1154380996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 25MA04735600
- Practice address
- 721 N Beers St
Suite 1-F
Holmdel, NJ 07733-1518 - Phone
- (732) 888-9100
- Fax
- (732) 888-5515
- NPI assigned
- Mar 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 25MA04735600 | NJ | Primary |
Addresses
Primary practice location
721 N Beers St
Suite 1-F
Holmdel, NJ 07733-1518
Mailing address
721 N Beers St
Suite 1-F
Holmdel, NJ 07733-1518
Phone (732) 888-9100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3266206 | Medicaid | NJ |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110325000024 | NJ | Practitioner - Nephrology | 7113100397 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Nephrology
- Education
- Other, 1976
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Nephrology Services Medical Group of New Jersey
Practice addresses (Care Compare)
1 Bethany Rd
Suite 85
Hazlet, NJ 07730-1669
Phone (732) 888-9100
Hospital & facility affiliations
- DaVita Holmdel Dialysis
- DaVita Wall Township Home Training
- Bayshore Medical Center
- Riverview Medical Center
- Raritan Bay Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nephrology Services Medical Group of New Jersey | Nephrology | Current | Accepting new patients |
Locations
1 Bethany Rd
Ste 85
Hazlet, NJ 07730
Phone (732) 264-5005
721 N Beers St
Ste 1F
Holmdel, NJ 07733
Phone (732) 888-9100
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 and National Provider Directory roles.
-
- Nephrology Physician
- Holmdel, NJ
- NPI 1568409464
Nephrology, NJ
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Wall Township, NJ
- NPI 1609289230
Dialysis facility
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Hazlet, NJ
- NPI 1700815487
Dialysis facility
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282176000000",
"number": "1154380996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "721 N BEERS ST",
"address_2": "SUITE 1-F",
"city": "HOLMDEL",
"state": "NJ",
"postal_code": "077331518",
"telephone_number": "732-888-9100",
"fax_number": "732-888-5515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "721 N BEERS ST",
"address_2": "SUITE 1-F",
"city": "HOLMDEL",
"state": "NJ",
"postal_code": "077331518",
"telephone_number": "732-888-9100",
"fax_number": "732-888-5515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTRAKJI",
"first_name": "JEAN",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-21",
"last_updated": "2010-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "NJ",
"license": "25MA04735600",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3266206",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Holmdel, NJ
- Ophthalmic Physicians of Monmouth PA
- Orthopaedic & Sports Medicine Specialists,Inc
- Orthopaedic and Sports Medicine Specialists, Inc
- Orthopaedic Sports Medicine and Rehabilitation Center, LLC
- Frank Ortolano, DDS
- Jeniffer Jenn Paez, DMD
- Adhith Venkata Sai Palla, BS
- Jennifer Palmieri, RN-BSN
- Manthan Pandya
- Pantocrator Family Chiropractic
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.