Active NPI
Thomas W Materna, M.D.
- Ophthalmology Physician
- Newark, NJ
National Provider Identifier
1356480503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 25MA03400000
- Practice address
- 20 Ferry St
Newark, NJ 07105-1420 - Phone
- (973) 589-0104
- Fax
- (973) 589-5084
- NPI assigned
- Feb 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 25MA03400000 | NJ | Primary |
Addresses
Primary practice location
20 Ferry St
Newark, NJ 07105-1420
Mailing address
87 Lorraine Ave
Upper Montclair, NJ 07043-2304
Phone (973) 744-4265
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1465201 | Medicaid | NJ | |
| 061280694 | Other | NJ | TAX ID |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The New York Eye & Ear Infirmary Ophthalmology Associates, P.C. | Past | Accepting new patients | |
| Associated Eye Physicians, P.a. | Ophthalmology | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/22072/brand/1/csg/1/fhir/r4
Organizations & group practices 3
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.
-
- Ophthalmology Physician
- Clifton, NJ
- NPI 1568617330
-
- Ophthalmology Physician
- Clifton, NJ
- NPI 1396787685
-
- Specialist
- New York, NY
- NPI 1811931041
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389571200000",
"number": "1356480503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "87 LORRAINE AVE",
"city": "UPPER MONTCLAIR",
"state": "NJ",
"postal_code": "070432304",
"telephone_number": "973-744-4265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 FERRY ST",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071051420",
"telephone_number": "973-589-0104",
"fax_number": "973-589-5084"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATERNA",
"first_name": "THOMAS",
"middle_name": "W",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-05",
"last_updated": "2014-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NJ",
"license": "25MA03400000",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1465201",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "061280694",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2014; 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.