Charles M. Stivala, DO

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

25MB10453400 Issued in NJ

Practice address

65 W Jimmie Leeds Rd
Pomona, NJ 08240-9102

Phone

(609) 748-7089

Fax

(609) 652-3460

NPI assigned

Sep 23, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Atlanticare Physician Group PA

  • Clinic/Center
  • Egg Harbor Township, NJ
  • NPI 1093829608

  Surgery

  Medicare reassignment NPD
• Virtua Medical Group, PA

  • Family Medicine Physician
  • Marlton, NJ
  • NPI 1649226515

  Surgery

  Medicare reassignment NPD
• Atlanticare Physician Group

  • Clinical Social Worker
  • Egg Harbor Township, NJ
  • NPI 1881618494
  NPD
• Atlanticare Physician Group, PA

  • Urgent Care Clinic/Center
  • Galloway, NJ
  • NPI 1003820622
  NPD
• Virtua Medical Group, PA

  • Orthopaedic Surgery Physician
  • Delran, NJ
  • NPI 1841087988
  NPD
• Virtua Medical Group, PA

  • Foot & Ankle Surgery Podiatrist
  • Marlton, NJ
  • NPI 1902356215
  NPD
• Community Medical Care, Inc

  • Internal Medicine Physician
  • Scranton, PA
  • NPI 1295789287

  Surgery

  NPD (past)

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1295721447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 ROUTE 66 FL 3",
            "city": "NEPTUNE",
            "state": "NJ",
            "postal_code": "077532645",
            "telephone_number": "732-807-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 W JIMMIE LEEDS RD",
            "city": "POMONA",
            "state": "NJ",
            "postal_code": "082409102",
            "telephone_number": "609-748-7089",
            "fax_number": "609-652-3460"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 Mulberry St",
            "address_purpose": "LOCATION",
            "city": "Scranton",
            "state": "PA",
            "postal_code": "185102369",
            "country_code": "US",
            "telephone_number": "570-969-7355",
            "fax_number": "570-969-7354",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STIVALA",
        "first_name": "CHARLES",
        "middle_name": "M.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "OS012844",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NJ",
            "license": "25MB10453400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0666726",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100816858",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory Smallwood, D.C.
• Nina Andrew Smith, MD
• Scott Alan Snively, RPH
• Susan Frances Somers, RN
• Anna Kate Spence, CRNA
• Nicole A Sturgill, DPT
• Jiawei Sun, M.D.
• Edward L Sung, M.D.
• Susan Thomas, RN, MSN, IBCLC
• Jennifer Tioseco, MD

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Pomona, NJ
• Providers in Pomona, NJ by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2023; 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.