Elizabeth Fagan, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MA074625 Issued in NJ

Practice address

12 Bank St Ste 201
Summit, NJ 07901-3661

Phone

(908) 376-6550

NPI assigned

Feb 6, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective May 15, 2019 through May 15, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Practice Associates,Inc

  • Physician Assistant
  • Morristown, NJ
  • NPI 1699733907

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367366400000",
    "number": "1295707156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 BANK ST STE 201",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079013661",
            "telephone_number": "908-376-6550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 BANK ST STE 201",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079013661",
            "telephone_number": "908-376-6550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "ELIZABETH",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-06",
        "last_updated": "2013-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "MA074625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Azadeh Esmaeili, MD
• Jarlene Estopia, MS, APRN, A-GNP-C
• Debbie Lynn Evans, LCSW
• Huberline Exantus, PMHNP
• Kelly Fabricatore, MS, CCC-SLP
• William Patrick Fahy
• Anila Faizan, M.D.
• Samuel Fam
• Family Health and Wellness Services
• Family Orthopedics, P.C.

• Family Medicine Physician in Summit, NJ
• Providers in Summit, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2013; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.