NPIMap

Organization Active NPI

St. Luke'S Warren Physician Group, PC

  • Gynecologic Oncology Physician
  • Phillipsburg, NJ
National Provider Identifier
1174864490
Registry record updated Apr 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
Legal business name
ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Practice address
123A Roseberry St
Phillipsburg, NJ 08865-1629
Phone
(484) 526-7555
Fax
(866) 281-9054
NPI assigned
Mar 12, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2023

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

Authorized official

Name
Susan Chiavaroli
Title
Manager
Phone
(484) 526-3569

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecologic Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VX0201X Primary

Addresses

Primary practice location

123A Roseberry St
Phillipsburg, NJ 08865-1629

Mailing address

755 Memorial Pkwy
Phillipsburg, NJ 08865-2748
Phone (484) 526-7555

Other identifiers 1

IdentifierTypeStateIssuer
0678198MedicaidNJ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040323000967 NJ Part B Supplier - Clinic/Group Practice 9739093675 Receives reassigned benefits from 216 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Phillipsburg, NJ; Washington, NJ; Hampton, NJ

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory

Locations

123A Roseberry St
Phillipsburg, NJ 08865
Phone (484) 526-7555

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1363046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680480000000",
    "number": "1174864490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 MEMORIAL PKWY",
            "city": "PHILLIPSBURG",
            "state": "NJ",
            "postal_code": "088652748",
            "telephone_number": "484-526-7555",
            "fax_number": "866-281-9054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123A ROSEBERRY ST",
            "city": "PHILLIPSBURG",
            "state": "NJ",
            "postal_code": "088651629",
            "telephone_number": "484-526-7555",
            "fax_number": "866-281-9054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LUKE'S WARREN PHYSICIAN GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-12",
        "last_updated": "2023-04-03",
        "certification_date": "2023-04-03",
        "status": "A",
        "authorized_official_last_name": "CHIAVAROLI",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "484-526-3569"
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0678198",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phillipsburg, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2023; 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.