NPIMap

Individual provider Active NPI

Jayram Krishnan, D.O., M.B.A.

  • Urology Physician
  • Voorhees, NJ
National Provider Identifier
1245216605
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
25MB08869800 Issued in NJ
Practice address
136 Route 73
Voorhees, NJ 08043-9598
Phone
(877) 388-2778
Fax
(856) 424-7529
NPI assigned
Dec 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 25MB08869800 NJ Primary

Addresses

Primary practice location

136 Route 73
Voorhees, NJ 08043-9598

Mailing address

1 Diamond Hill Rd
Berkeley Heights, NJ 07922-2104
Phone (908) 273-4300

Other practice location 1

3131 La Canada St
Suite 217
Las Vegas, NV 89169-2578
Phone (702) 796-8669

Other identifiers 2

IdentifierTypeStateIssuer
25MB08869800OtherNJNJ STATE MEDICAL LICENSE
DO1872OtherNVSTATE LICENSE

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
I20230713003221 NJ Practitioner - Urology 9335373471 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
New York College of Osteo Medicine of New York Institute of Technology, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Summit Medical Group PAGroup PAC ID 5395642276, 1,204 clinicians

Practice addresses (Care Compare)

1 Diamond Hill Rd
Berkeley Heights, NJ 07922-2104
Phone (908) 273-4300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection21
Removal of the uterus1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Master of Business Administration

State licenses

LicenseStateTypeSpecialty
25MB08869800NJMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Euclid Hospital Cleveland Clinic Health System Current Accepting new patients
Summit Medical Group PA CurrentSince Jun 26, 2023 Accepting new patients
Summit Medical Group PA CurrentSince Jun 26, 2023 Accepting new patients

Locations

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

150 Floral Ave
New Providence, NJ 07974
Phone (908) 588-3890

Interoperability endpoints

  • Direct secure messaging: jkrishnandomba241571@direct.ccf.org

Organizations & group practices 3

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 9

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": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1245216605",
    "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": "908-273-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 ROUTE 73",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080439598",
            "telephone_number": "877-388-2778",
            "fax_number": "856-424-7529"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3131 La Canada St",
            "address_2": "Suite 217",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891692578",
            "country_code": "US",
            "telephone_number": "702-796-8669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRISHNAN",
        "first_name": "JAYRAM",
        "name_prefix": "Dr.",
        "credential": "D.O., M.B.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-19",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NJ",
            "license": "25MB08869800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NJ STATE MEDICAL LICENSE",
            "identifier": "25MB08869800",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "DO1872",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Voorhees, NJ

Sources for this page

Verify at the official NPI Registry.