NPIMap

Organization Active NPI

Bridgecare Provider Group LLC

  • Primary Care Nurse Practitioner
  • Wayne, NJ
National Provider Identifier
1164148672
Registry record updated Oct 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
BRIDGECARE PROVIDER GROUP LLC
Practice address
493 Black Oak Ridge Rd
Wayne, NJ 07470-6501
Phone
(973) 692-9500
NPI assigned
Oct 17, 2022
Last updated
Oct 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2022

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

Authorized official

Name
Dr. Iyad BakerNPI 1730341322
Title
Owner
Phone
(201) 596-6262

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X NU Primary
Adult Development & Aging Psychologist 103TA0700X NU
Clinical Social Worker 1041C0700X NU

Addresses

Primary practice location

493 Black Oak Ridge Rd
Wayne, NJ 07470-6501

Mailing address

173 Bridge PLZ N
Fort Lee, NJ 07024-7575

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230109001004 NJ Part B Supplier - Clinic/Group Practice 8123498193 Receives reassigned benefits from 33 practitioners
Practice locations: Wayne, NJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1665964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665964800000",
    "number": "1164148672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "173 BRIDGE PLZ N",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070247575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "493 BLACK OAK RIDGE RD",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074706501",
            "telephone_number": "973-692-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGECARE PROVIDER GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-17",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "IYAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-596-6262",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.