NPIMap

Individual provider Active NPI

Roy J Fertakos, MD

  • Diagnostic Radiology Physician
  • Bethlehem, PA
National Provider Identifier
1356448773
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
062399L Issued in PA
Practice address
801 Ostrum St
Bethlehem, PA 18015-1000
Phone
(484) 526-4000
Fax
(706) 653-1230
NPI assigned
Sep 20, 2006
Last updated
Sep 3, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 25MA05686200 NJ
Diagnostic Radiology Physician 2085R0202X 25MA05686200 NJ
Diagnostic Radiology Physician 2085R0202X 062399L PA Primary

Addresses

Primary practice location

801 Ostrum St
Bethlehem, PA 18015-1000

Mailing address

PO Box 678398
Dallas, TX 75267-8398
Phone (800) 475-6112

Other practice location 1

330 Ratzer Rd
Suite A6
Wayne, NJ 07470-7702
Phone (973) 696-5770

Other identifiers 6

IdentifierTypeStateIssuer
001668701MedicaidPA
300110976OtherNJRAILROAD MEDICARE - BRIDGEWATER
300110976OtherNJRAILROAD MEDICARE - EDISON
8224005MedicaidNJ
300110976OtherNJRAILROAD MEDICARE - WARREN
300110976OtherNJRAILROAD MEDICARE - SMC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050526000248 NJ Practitioner - Diagnostic Radiology 2163464439 Reassigns benefits to 2 organizations
I20190912000024 PA Practitioner - Diagnostic Radiology 2163464439 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Rutgers R W Johnson Medical School (Cam/New Bruns/Pisc), 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Progressive Physician Assoc IncGroup PAC ID 1355243809, 164 clinicians

Practice addresses (Care Compare)

185 Roseberry St
Phillipsburg, NJ 08865-1690
Phone (908) 859-6700

801 Ostrm St
Bethlehem, PA 18015-1000
Phone (610) 868-1100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
062399LPAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The New Jersey Imaging Network, LLC Multi-Specialty CurrentSince Jan 1, 2015 Accepting new patients
Progressive Physician Assoc Inc Multi-Specialty CurrentSince Sep 1, 2019 Accepting new patients
Princeton Radiology Associates, P.a. Multi-Specialty Past Accepting new patients
Hillsborough Radiology Associates, LLC Multi-Specialty Past Accepting new patients
Associated Radiologists PA Multi-Specialty Past Accepting new patients
Hillsborough Radiology Centers, LLC Multi-Specialty PastSince Dec 1, 2016 Accepting new patients

Locations

27695 Network Pl
Chicago, IL 60673

36 Newark Ave
Ste 100
Belleville, NJ 07109
Phone (973) 844-4170

197 Ridgedale Ave
Cedar Knolls, NJ 07927
Phone (973) 292-0700

17 White Horse Pike
Ste 9
Haddon Hgts, NJ 08035
Phone (856) 546-1177

185 Roseberry St
Phillipsburg, NJ 08865
Phone (908) 213-6611

1736 Hamilton St
Allentown, PA 18104
Phone (610) 770-8300

421 Chew St
Allentown, PA 18102
Phone (610) 776-4500

303 W Broad St
Bethlehem, PA 18018
Phone (610) 865-0311

3 Parkinsons Rd
East Stroudsburg, PA 18301
Phone (570) 424-1102

1872 St Lukes Blvd
Easton, PA 18045
Phone (484) 503-1200

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

211 N 12th St
Lehighton, PA 18235
Phone (610) 377-1300

100 Paramount Blvd
Orwigsburg, PA 17961
Phone (272) 639-1000

135 Lafayette Ave
Palmerton, PA 18071
Phone (610) 826-1103

100 St Lukes Ln
Stroudsburg, PA 18360
Phone (272) 212-1000

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599091200000",
    "number": "1356448773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 678398",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752678398",
            "telephone_number": "800-475-6112",
            "fax_number": "706-653-1230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 OSTRUM ST",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180151000",
            "telephone_number": "484-526-4000",
            "fax_number": "706-653-1230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "330 Ratzer Rd",
            "address_2": "Suite A6",
            "address_purpose": "LOCATION",
            "city": "Wayne",
            "state": "NJ",
            "postal_code": "074707702",
            "country_code": "US",
            "telephone_number": "973-696-5770",
            "fax_number": "973-633-1204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERTAKOS",
        "first_name": "ROY",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA05686200",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NJ",
            "license": "25MA05686200",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "062399L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001668701",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE - BRIDGEWATER",
            "identifier": "300110976",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE - EDISON",
            "identifier": "300110976",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8224005",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE - WARREN",
            "identifier": "300110976",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE - SMC",
            "identifier": "300110976",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethlehem, PA

Sources for this page

Verify at the official NPI Registry.