NPIMap

Individual provider Active NPI

Geronimo Banayat, M.D.

  • Internal Medicine Physician
  • Clark, NJ
National Provider Identifier
1376620500
Registry record updated Feb 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MA51978 Issued in NJ
Practice address
29 Broadway
Clark, NJ 07066-2557
Phone
(732) 574-1887
NPI assigned
Nov 1, 2006
Last updated
Feb 25, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 25, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MA51978 NJ Primary
Nephrology Physician 207RN0300X MA51978 NJ

Addresses

Primary practice location

29 Broadway
Clark, NJ 07066-2557

Mailing address

29 Broadway
Clark, NJ 07066-2557
Phone (732) 574-1887

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110314001007 NJ Practitioner - Internal MedicinePractitioner - Nephrology 4688856578 Reassigns benefits to 1 organization
Practice locations: Clark, NJ

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Institute for Hypertension and Kidney Diseases, P.C.Group PAC ID 8820189129, 7 clinicians

Practice addresses (Care Compare)

546 Saint Georges Ave
Rahway, NJ 07065-2542
Phone (732) 381-3642

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Institute for Hypertension and Kidney Diseases PC Internal Medicine CurrentSince Apr 26, 2019 Accepting new patients
University Physician Associates of New Jersey Inc Past Accepting new patients
Trinitas Regional Medical Center Past Accepting new patients
Nikita Varshneya, M.D P.a Past Accepting new patients

Locations

240 Williamson St
Ste 206
Elizabeth, NJ 07202
Phone (908) 353-6668

Organizations & group practices 4

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 12

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": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582588800000",
    "number": "1376620500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 BROADWAY",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070662557",
            "telephone_number": "732-574-1887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 BROADWAY",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070662557",
            "telephone_number": "732-574-1887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANAYAT",
        "first_name": "GERONIMO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MA51978",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NJ",
            "license": "MA51978",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clark, NJ

Sources for this page

Verify at the official NPI Registry.