Mavis Camalita Ermakov, R.D., RN., CDE., APN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

26NJ00421400 Issued in NJ

Practice address

741 Broadway
Newark, NJ 07104-4309

Phone

(973) 483-1300

NPI assigned

Dec 4, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Electronic endpoints 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HBFIAA
• Direct secure messaging: mavis.ermakov@sdapcl-nj.direct.office.nextgen.com

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.

• Newark Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
  • NPI 1740345693
  Medicare reassignment NPD
• Sivam Healthcare Training Incorporated

  • Home Health Agency
  • Newark, NJ
  • NPI 1679303069
  NPD Authorized official
• Newark Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
  • NPI 1366993586
  NPD
• Sivam Diabetes, Nutrition and Family Healthcare LLC

  • Family Nurse Practitioner
  • East Orange, NJ
  • NPI 1568974418

  Nutrition, Metabolic

  NPD
• Jersey City Medical Center

  • General Acute Care Hospital
  • Jersey City, NJ
  • NPI 1689744856
  NPD (past)

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1265614911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 LIBERTY CT",
            "city": "PISCATAWAY",
            "state": "NJ",
            "postal_code": "088547206",
            "telephone_number": "732-937-5952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 BROADWAY",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071044309",
            "telephone_number": "973-483-1300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "731 Liberty Ct",
            "address_purpose": "LOCATION",
            "city": "Piscataway",
            "state": "NJ",
            "postal_code": "088547206",
            "country_code": "US",
            "telephone_number": "732-937-5952",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ERMAKOV",
        "first_name": "MAVIS",
        "middle_name": "CAMALITA",
        "name_prefix": "Dr.",
        "credential": "R.D., RN., CDE., APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-04",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "0071705",
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "IL",
            "license": "717052 (ID#)",
            "primary": false
        },
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "NJ",
            "license": "26NR112011600",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00421400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0143533620",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "sivam.diabetes.llc@gmail.com",
            "affiliation": "Y",
            "endpointDescription": "Email",
            "affiliationName": "SIVAM DIABETES & PRIMARY CARE LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "health information",
            "address_1": "731 Liberty Ct",
            "city": "Piscataway",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "08854",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Equip Health Medical NJ PC
• Fareeda Eraky
• Sandra Elena Erazo Posada
• Migdalia Erazo, RN,APN
• Aybala Erek Toprak
• Elizabeth Ervin
• Lakesha Ruby Ervin
• Marsha Escalliere
• Ashley Escobar, LAC
• Jared Alexander Escobar, MD

• Family Nurse Practitioner in Newark, NJ
• Providers in Newark, NJ by specialty
• Family Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.