NPIMap

Organization Active NPI

Summit Medical Group PA

  • Durable Medical Equipment & Medical Supplies
  • Fair Lawn, NJ
National Provider Identifier
1194537571
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
SUMMIT MEDICAL GROUP PA
Practice address
17-17 Route 208
Fair Lawn, NJ 07410-2820
Phone
(201) 625-1560
NPI assigned
Jan 23, 2025
Last updated
Jan 23, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SUMMIT MEDICAL GROUP PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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

Authorized official

Name
Swahili Henry
Title
Director of Provider Enrollments
Phone
(212) 913-0828

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

17-17 Route 208
Fair Lawn, NJ 07410-2820

Mailing address

1 Diamond Hill Rd
Berkeley Heights, NJ 07922-2104
Phone (908) 588-3635

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250429002189 NJ DME Supplier - Physician - Orthopedic/Orthopedic SurgeryDME Supplier - Physician - PodiatryDME Supplier - Physician - Physical and Rehabilitation 5395642276 Practice locations: Fair Lawn, NJ

Other NPIs with the same Medicare PAC ID 23

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 23

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D2208009Summit Medical Group PA17-17 Route 208, Fair Lawn, NJ 07410Certificate of waiverJan 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Summit Medical GRP PA84 organizations share this tax ID, including this one
Part of
Summit Medical GRP PA

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1 Diamond Hill Rd
Berkeley Heights, NJ 07922
Phone (908) 277-8868

NPI Registry JSON

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

{
    "created_epoch": "1737590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737590400000",
    "number": "1194537571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 DIAMOND HILL RD",
            "city": "BERKELEY HEIGHTS",
            "state": "NJ",
            "postal_code": "079222104",
            "telephone_number": "908-588-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17-17 ROUTE 208",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074102820",
            "telephone_number": "201-625-1560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT MEDICAL GROUP PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUMMIT MEDICAL GROUP PA",
        "enumeration_date": "2025-01-23",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "SWAHILI",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER ENROLLMENTS",
        "authorized_official_telephone_number": "212-913-0828"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fair Lawn, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.