Individual provider Active NPI

Colin Russell O'Reilly, D.O.

  • Pediatric Critical Care Medicine Physician
  • New Brunswick, NJ
National Provider Identifier
1356671887
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
25MB08636600 Issued in NJ
Practice address
200 Somerset St
New Brunswick, NJ 08901-1942
Phone
(732) 258-7000
NPI assigned
Jan 6, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X 25MB08636600 NJ Primary

Addresses

Primary practice location

200 Somerset St
New Brunswick, NJ 08901-1942

Mailing address

200 Somerset St
New Brunswick, NJ 08901-1942
Phone (732) 258-7000

Other practice location 1

100 Madison Ave
Morristown, NJ 07960-6136
Phone (973) 971-7550

Other practice location 2

100 Madison Ave
Morristown, NJ 07960-6136
Phone (973) 971-7550

Other identifiers 1

IdentifierTypeStateIssuer
0232050MedicaidNJ

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100916000162 NJ Practitioner - Pediatric Medicine 6608991534 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MB08636600NJMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children' Specialized Hospital CurrentSince Jun 2, 2016 Accepting new patients
Children'S Specialized Hospital CurrentSince Jun 2, 2016 Accepting new patients

Locations

150 New Providence Rd
Mountainside, NJ 07092

200 Somerset St
New Brunswick, NJ 08901
Phone (732) 258-7000

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": "1262736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1356671887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 SOMERSET ST",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089011942",
            "telephone_number": "732-258-7000",
            "fax_number": "908-389-5675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SOMERSET ST",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089011942",
            "telephone_number": "732-258-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Madison Ave",
            "address_purpose": "LOCATION",
            "city": "Morristown",
            "state": "NJ",
            "postal_code": "079606136",
            "country_code": "US",
            "telephone_number": "973-971-7550",
            "fax_number": "973-290-7364",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Madison Ave",
            "address_purpose": "LOCATION",
            "city": "Morristown",
            "state": "NJ",
            "postal_code": "079606136",
            "country_code": "US",
            "telephone_number": "973-971-7550",
            "fax_number": "973-290-7364",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'REILLY",
        "first_name": "COLIN",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-06",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "NJ",
            "license": "25MB08636600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0232050",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Brunswick, NJ

Sources for this page

Verify at the official NPI Registry.