Individual provider Active NPI

Jennifer Souh

  • Anesthesiology Physician
  • Ridgewood, NJ
National Provider Identifier
1235373176
Registry record updated Aug 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
25MA089965 Issued in NJ
Practice address
223 N Van Dien Ave
Ridgewood, NJ 07450-2726
Phone
(201) 847-9320
NPI assigned
Apr 22, 2009
Last updated
Aug 29, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 25MA089965 NJ Primary

Addresses

Primary practice location

223 N Van Dien Ave
Ridgewood, NJ 07450-2726

Mailing address

500 W Main St Ste 16
Wyckoff, NJ 07481-1406
Phone (201) 847-9320

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
I20120315000535 NJ Practitioner - Anesthesiology 8123287885 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Loma Linda University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bergen Anesthesia Group, P.C.Group PAC ID 6608861794, 61 clinicians

Practice addresses (Care Compare)

223 N Van Dien Ave
Ridgewood, NJ 07450-2726
Phone (201) 847-9403

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
60.05 of 100Reported as group
Quality
46.59
Improvement activities
40
Cost
64.74

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA089965NJMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bergen Anesthesia Group, P.C. CurrentSince Jul 1, 2016 Accepting new patients
Valley Physician Services PC CurrentSince Mar 10, 2020 Accepting new patients

Locations

223 N Van Dien Ave
Ridgewood, NJ 07450
Phone (201) 447-8417

500 W Main St
Ste 16
Wyckoff, NJ 07481
Phone (201) 847-9320

Organizations & group practices 2

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": "1240358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693267200000",
    "number": "1235373176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W MAIN ST STE 16",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074811406",
            "telephone_number": "201-847-9320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 N VAN DIEN AVE",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074502726",
            "telephone_number": "201-847-9320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUH",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-22",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NJ",
            "license": "25MA089965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgewood, NJ

Sources for this page

Verify at the official NPI Registry.