Individual provider Active NPI

Anthony Martin Jadick, CRNA

  • Registered Nurse
  • Vineland, NJ
National Provider Identifier
1205912391
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
26NR05322900 Issued in NJ
Practice address
1051 W Sherman Ave
BLDG.2 Suite a
Vineland, NJ 08360-6931
Phone
(856) 691-0200
NPI assigned
Oct 31, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 26NR05322900 NJ Primary

Addresses

Primary practice location

1051 W Sherman Ave
BLDG.2 Suite a
Vineland, NJ 08360-6931

Mailing address

1448 Jesse Bridge Rd
Elmer, NJ 08318-4562
Phone (856) 692-2609

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040129000133 NJ Practitioner - Certified Registered Nurse Anesthetist (Crna) 6800799743
I20080312000468 PA Practitioner - Certified Registered Nurse Anesthetist (Crna) 6800799743 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2301 S Broad St
Philadelphia, PA 19148-3542
Phone (215) 952-5175

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
26NR05322900NJMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Associates in Healthcare, Inc Current Accepting new patients
Methodist Associates in Healthcare, Inc CurrentSince Jan 12, 2018 Accepting new patients
Methodist Associates in Healthcare, Inc CurrentSince Jan 12, 2018 Accepting new patients
Cooper Anesthesia Associates, PC Past Accepting new patients
Atlanticare Regional Medical Center Past Accepting new patients

Locations

2301 S Broad St
Philadelphia, PA 19148
Phone (215) 952-9000

2301 S Broad St
Ste 102
Philadelphia, PA 19148
Phone (215) 952-5175

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205912391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1448 JESSE BRIDGE RD",
            "city": "ELMER",
            "state": "NJ",
            "postal_code": "083184562",
            "telephone_number": "856-692-2609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 W SHERMAN AVE",
            "address_2": "BLDG.2 SUITE A",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083606931",
            "telephone_number": "856-691-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JADICK",
        "first_name": "ANTHONY",
        "middle_name": "MARTIN",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NJ",
            "license": "26NR05322900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineland, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.