NPIMap

Organization Active NPI

Advanced Vascular Associates, Inc.

  • Surgery Physician
  • Woodbury, NJ
National Provider Identifier
1154402154
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD032074E Issued in PA
Legal business name
ADVANCED VASCULAR ASSOCIATES, INC.
Practice address
127 N Broad St
Woodbury, NJ 08096-1718
Phone
(856) 845-5344
Fax
(856) 384-8757
NPI assigned
Oct 17, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Kent S Haas, M.D.NPI 1528089018
Title
Owner/President
Phone
(856) 845-5344

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
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X MD032074E PA Primary

Addresses

Primary practice location

127 N Broad St
Woodbury, NJ 08096-1718

Mailing address

127 N Broad St
Woodbury, NJ 08096-1718
Phone (856) 845-5344

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA, DE3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20070104000276 NJ Part B Supplier - Clinic/Group Practice 6002816683 Receives reassigned benefits from 1 practitioner
Practice locations: Woodbury, NJ
O20070221000362 PA Part B Supplier - Clinic/Group Practice 6002816683 Receives reassigned benefits from 11 practitioners
Practice locations: Philadelphia, PA
O20181120001167 DE Part B Supplier - Clinic/Group Practice 6002816683 Receives reassigned benefits from 1 practitioner
Practice locations: Newark, DE; Wilmington, DE

National Provider Directory

National Provider Directory

Locations

79 Omega Dr
Bldg C79
Newark, DE 19713
Phone (856) 845-5344

Interoperability endpoints

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

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154402154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 N BROAD ST",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080961718",
            "telephone_number": "856-845-5344",
            "fax_number": "856-384-8757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 N BROAD ST",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080961718",
            "telephone_number": "856-845-5344",
            "fax_number": "856-384-8757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED VASCULAR ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HAAS",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "856-845-5344",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD032074E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.