NPIMap

Organization Active NPI

Centrastate Medical Center, Inc

  • General Acute Care Hospital
  • Freehold, NJ
National Provider Identifier
1295718450
Registry record updated May 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
11302 Issued in NJ
Legal business name
CENTRASTATE MEDICAL CENTER, INC
Practice address
901 W Main St
Business Office
Freehold, NJ 07728-2537
Phone
(732) 294-7010
Fax
(732) 303-9251
NPI assigned
Nov 22, 2005
Last updated
May 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2025

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

Authorized official

Name
Janice McAvenia
Title
Exec Dir, Revenue Cycle Operations
Phone
(732) 294-7012

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 11302 NJ Primary

Addresses

Primary practice location

901 W Main St
Business Office
Freehold, NJ 07728-2537

Mailing address

901 W Main St
Administration
Freehold, NJ 07728-2537
Phone (732) 294-2528

Other identifiers 2

IdentifierTypeStateIssuer
4141016MedicaidNJ
4141008MedicaidNJ

Electronic endpoints 3

TypeEndpointUseAffiliation
FHIR URL https://fhir-myrecord.cerner.com/dstu2/b9b77dc1-8db8-486e-b0ce-6b2a89edb7e5
Direct Messaging Address soen@scs.centraxchangedirect.org
CONNECT URL https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler Other CMS HIH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050705000210 NJ Part B Supplier - Clinic/Group Practice 9739125428 Receives reassigned benefits from 15 practitioners
Practice locations: Freehold, NJ
O20081213000195 NJ Part A Provider - Hospital 9739125428 Practice locations: East Windsor, NJ; Monroe, NJ; Marlboro, NJ; Manalapan, NJ; Jackson, NJ; Freehold, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295718450. Details of each certification follow.

Hospital certification: CCN 310111

Legal name
CENTRASTATE MEDICAL CENTER INC.
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Sep 20, 1971
Last certification
May 3, 2024
Beds
273
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
901 W Main St
Business Office
Freehold, NJ 77282537
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Centrastate Medical CenterCCN 310111 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Cesar R Quezada MD4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Maureen Lawrence Individual Other Aug 2, 2019
Ashish Awasthi Individual Other Aug 2, 2019
Peter Licata Individual Other Aug 2, 2019
Maher a Youssef Individual Other Aug 2, 2019
Gerard Norkus Individual Other Aug 2, 2019
Deborah Connors Individual W-2 Managing EmployeeAd; Jul 7, 2008 50%
Kenneth Reilly Individual Other Aug 2, 2019
John Dellocono Individual Corporate Director Jul 7, 2008
W-2 Managing Employee Jul 7, 2008
John Gribbin Individual Corporate OfficerCeo Oct 1, 2000 100%
Thomas Scott Individual Corporate OfficerChief Executive Officer Jan 1, 2021 50%
George Anthony Quintano Individual W-2 Managing EmployeeExecutive Director, PFS Jan 1, 2025
John Cantalupo Individual Other Aug 2, 2019
Nadia Batchelor Individual OtherSecretary/Treasurer Oct 1, 2021
Janice McAvenia Individual W-2 Managing EmployeeExecutive Director, Rev Cycle Ops Jul 7, 2008
John Eggert Individual Other Aug 2, 2019
John P Detullio Individual Other Aug 2, 2019
Atlantic Health System Organization, Morristown, NJ Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2022 51%
Robert Gordon Individual Other Aug 2, 2019

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 61

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.

View all 61

Affiliated clinicians 959

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 959

NPI Registry JSON

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747612800000",
    "number": "1295718450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 W MAIN ST",
            "address_2": "ADMINISTRATION",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077282537",
            "telephone_number": "732-294-2528",
            "fax_number": "732-462-5129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W MAIN ST",
            "address_2": "BUSINESS OFFICE",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077282537",
            "telephone_number": "732-294-7010",
            "fax_number": "732-303-9251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRASTATE MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-22",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A",
        "authorized_official_last_name": "MCAVENIA",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "EXEC DIR, REVENUE CYCLE OPERATIONS",
        "authorized_official_telephone_number": "732-294-7012"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NJ",
            "license": "11302",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4141016",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4141008",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir-myrecord.cerner.com/dstu2/b9b77dc1-8db8-486e-b0ce-6b2a89edb7e5",
            "affiliation": "N",
            "address_1": "901 W Main St",
            "city": "Freehold",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "077282549",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "soen@scs.centraxchangedirect.org",
            "affiliation": "N",
            "address_1": "901 W Main St",
            "city": "Freehold",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "077282549",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "CMS HIH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "7500 Security Blvd",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212441849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Freehold, NJ

Sources for this page

Verify at the official NPI Registry.