Individual provider Active NPI

Sunil Kumar

  • Student in an Organized Health Care Education/Training Program
  • Elizabeth, NJ
National Provider Identifier
1316559347
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
655 E Jersey St
Elizabeth, NJ 07206-1259
Phone
(908) 994-5000
NPI assigned
Aug 20, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 75619 CT
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

655 E Jersey St
Elizabeth, NJ 07206-1259

Mailing address

655 E Jersey St
Elizabeth, NJ 07206-1259
Phone (908) 994-5000

Other practice location 1

189 Storrs Rd
Mansfield Center, CT 06250-1683
Phone (860) 456-1311

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20230815001795 CT Practitioner - Psychiatry 1153783691 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Impact Health Psych PCGroup PAC ID 6204248149, 20 clinicians

Practice addresses (Care Compare)

240 Indian River Rd
Suite C7
Orange, CT 06477-3691
Phone (203) 497-3867

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
75619CTMDPsychiatry Physician

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1597881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1316559347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 E JERSEY ST",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072061259",
            "telephone_number": "908-994-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 E JERSEY ST",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072061259",
            "telephone_number": "908-994-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "189 Storrs Rd",
            "address_purpose": "LOCATION",
            "city": "Mansfield Center",
            "state": "CT",
            "postal_code": "062501683",
            "country_code": "US",
            "telephone_number": "860-456-1311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUMAR",
        "first_name": "SUNIL",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-20",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "75619",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth, NJ

Sources for this page

Verify at the official NPI Registry.