Individual provider Active NPI

Mark C Reilly, MD

  • Orthopaedic Trauma Physician
  • Newark, NJ
National Provider Identifier
1184701492
Registry record updated Apr 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Trauma PhysicianTaxonomy code 207XX0801X
License
25MA06660500 Issued in NJ
Practice address
90 Bergen St
Doc 1200
Newark, NJ 07103-2425
Phone
(973) 972-2150
Fax
(973) 972-2155
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Trauma Physician 207XX0801X 25MA06660500 NJ Primary

Addresses

Primary practice location

90 Bergen St
Doc 1200
Newark, NJ 07103-2425

Mailing address

30 Bergen St
Admc 12 1205
Newark, NJ 07107-3000

Other identifiers 1

IdentifierTypeStateIssuer
7439300MedicaidNJ

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mreilly5935@direct.uhnj.org Direct University Hospital

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110425000092 NJ Practitioner - Orthopedic Surgery 1355526088 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

205 S Orange Ave
Suite 1200
Newark, NJ 07103-2785
Phone (973) 972-2151

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA06660500NJMDOrthopaedic Trauma Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Physician Associates of New Jersey Inc CurrentSince Jan 1, 1970 Accepting new patients
University Physician Associates of New Jersey Inc CurrentSince Jan 1, 1970 Accepting new patients
University Physician Associates of New Jersey Inc Past Accepting new patients
University Hospital Past Accepting new patients

Locations

150 Bergen St
Newark, NJ 07103
Phone (973) 972-6056

30 Bergen St
Rm 1205
Newark, NJ 07107
Phone (973) 972-0037

205 S Orange Ave
Newark, NJ 07103
Phone (973) 972-0670

205 S Orange Ave
Ste 1200
Newark, NJ 07103
Phone (973) 972-2151

205 S Orange Ave
#1200
Newark, NJ 07103
Phone (973) 972-2151

30 Bergen St
#12
Newark, NJ 07107
Phone (973) 972-0037

90 Bergen St
#1200
Newark, NJ 07103
Phone (973) 972-2150

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1184701492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 BERGEN ST",
            "address_2": "ADMC 12 1205",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071073000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 BERGEN ST",
            "address_2": "DOC 1200",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032425",
            "telephone_number": "973-972-2150",
            "fax_number": "973-972-2155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REILLY",
        "first_name": "MARK",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0801X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Trauma",
            "state": "NJ",
            "license": "25MA06660500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7439300",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mreilly5935@direct.uhnj.org",
            "affiliation": "Y",
            "endpointDescription": "Epic",
            "affiliationName": "University Hospital",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "150 Bergen St",
            "city": "Newark",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "071032496",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

Verify at the official NPI Registry.