NPIMap

Individual provider Active NPI

Javier Motta, PA

  • Physician Assistant
  • Madison, CT
National Provider Identifier
1194807180
Registry record updated Jul 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3176 Issued in CT
Practice address
146 Samson Rock Dr
Madison, CT 06443-3018
Phone
(203) 318-8000
NPI assigned
Oct 19, 2006
Last updated
Jul 24, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X P53986 NY
Physician Assistant 363A00000X 25MP00195700 NJ
Physician Assistant 363A00000X 3176 CT Primary

Addresses

Primary practice location

146 Samson Rock Dr
Madison, CT 06443-3018

Mailing address

146 Samson Rock Dr
Madison, CT 06443-3018
Phone (203) 318-8000

Other identifiers 1

IdentifierTypeStateIssuer
P53986OtherNYLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080514000374 NJ Practitioner - Physician Assistant 4688774276 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Excel Urgent Care of Paramus LLCGroup PAC ID 3971656018, 15 clinicians
Doctors Office of BrickGroup PAC ID 1254575061, 13 clinicians

Practice addresses (Care Compare)

110 E Ridgewood Ave
Paramus, NJ 07652-4025
Phone (201) 265-9500

686 Route 70
Brick, NJ 08723-4026
Phone (732) 262-8200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
011623NYMDClinical Psychologist
3176CTMDPhysician Assistant
25MP00195700NJMDPhysician Assistant
P53986NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Afc Physicians of Connecticut, PC CurrentSince Sep 3, 2017 Accepting new patients
Madison Avenue Emergency Medicine PC Past Accepting new patients
Lich Faculty Practice Physician Assistant Past Accepting new patients
Northern Westchester Emergency Medical Associates PLLC Past Accepting new patients
Pharma Holding Inc PastSince Jul 23, 2023 Accepting new patients
Essex Emergency Group PC Physician Assistant Past Accepting new patients
Fall Prevention and Rehabilitation, LLP Physician Assistant Past Accepting new patients
Garden State Healthcare Associates, LLC Past Accepting new patients
Long Island College Hospital Physician Assistant Past Accepting new patients
Atlantic Professional Services of New Jersey, P.a. Physician Assistant Past Accepting new patients
Hoboken Emergency Physicians, PC Past Accepting new patients

Locations

2 Main St
Danbury, CT 06810
Phone (203) 826-2140

Organizations & group practices 15

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437696000000",
    "number": "1194807180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 SAMSON ROCK DR",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064433018",
            "telephone_number": "203-318-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 SAMSON ROCK DR",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064433018",
            "telephone_number": "203-318-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOTTA",
        "first_name": "JAVIER",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2015-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "P53986",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00195700",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "3176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "P53986",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, CT

Sources for this page

Verify at the official NPI Registry.