NPIMap

Organization Active NPI

Island Medical Professional Association

  • Family Medicine Physician
  • Ship Bottom, NJ
National Provider Identifier
1265549539
Registry record updated Jul 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ISLAND MEDICAL PROFESSIONAL ASSOCIATION
Practice address
1812 Long Beach Blvd
Ship Bottom, NJ 08008-4443
Phone
(609) 494-2323
Fax
(609) 494-4141
NPI assigned
Aug 24, 2006
Last updated
Jul 5, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2011

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

Authorized official

Name
Dr. James Noland Suddeth, M.D.NPI 1992812275
Title
President
Phone
(609) 494-2323

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1812 Long Beach Blvd
Ship Bottom, NJ 08008-4443

Mailing address

1812 Long Beach Blvd
Ship Bottom, NJ 08008-4443
Phone (609) 494-2323

Other identifiers 1

IdentifierTypeStateIssuer
6175601MedicaidNJ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100430000344 NJ Part B Supplier - Clinic/Group Practice 4981731569 Receives reassigned benefits from 5 practitioners
Practice locations: Ship Bottom, NJ

National Provider Directory

National Provider Directory
Tax ID family
Island Medical Association2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1812 Long Beach Blvd
Ship Bottom, NJ 08008
Phone (609) 226-3007

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309824000000",
    "number": "1265549539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1812 LONG BEACH BLVD",
            "city": "SHIP BOTTOM",
            "state": "NJ",
            "postal_code": "080084443",
            "telephone_number": "609-494-2323",
            "fax_number": "609-494-4141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1812 LONG BEACH BLVD",
            "city": "SHIP BOTTOM",
            "state": "NJ",
            "postal_code": "080084443",
            "telephone_number": "609-494-2323",
            "fax_number": "609-494-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND MEDICAL PROFESSIONAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2011-07-05",
        "status": "A",
        "authorized_official_last_name": "SUDDETH",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "NOLAND",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "609-494-2323",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6175601",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ship Bottom, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.