Individual provider Active NPI

Matthew Parmar, PA-C

  • Physician Assistant
  • Maplewood, NJ
National Provider Identifier
1417566498
Registry record updated Dec 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00569000 Issued in NJ
Practice address
264 Boyden Ave
Maplewood, NJ 07040-3070
Phone
(973) 761-5200
NPI assigned
Jul 27, 2020
Last updated
Dec 31, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 25MP00569000 NJ Primary

Addresses

Primary practice location

264 Boyden Ave
Maplewood, NJ 07040-3070

Mailing address

264 Boyden Ave
Maplewood, NJ 07040-3070

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201006000621 NJ Practitioner - Physician Assistant 7517386840 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

506 Broadway
Bayonne, NJ 07002-3712
Phone (201) 471-7012

935 River Rd
Suite 301
Edgewater, NJ 07020-2233
Phone (201) 471-7012

Merit-based Incentive Payment System (MIPS)

Final score
85.15 of 100Reported as group
Quality
71.59
Promoting interoperability
100
Improvement activities
40
Cost
76.65

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care of New Jersey PC CurrentSince Nov 1, 2020 Accepting new patients
Optum Medical Care of New Jersey PC CurrentSince Nov 1, 2020 Accepting new patients
Riverside Medical Group Past Accepting new patients
A.G. Dikengil, MD, PA Past Accepting new patients

Locations

935 River Rd
Ste 301
Edgewater, NJ 07020
Phone (201) 471-7012

264 Boyden Ave
Maplewood, NJ 07040
Phone (973) 761-0764

Interoperability endpoints

  • Direct secure messaging: mparmar76824@direct.optum.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1595808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609372800000",
    "number": "1417566498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "264 BOYDEN AVE",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070403070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 BOYDEN AVE",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070403070",
            "telephone_number": "973-761-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARMAR",
        "first_name": "MATTHEW",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-27",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00569000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maplewood, NJ

Sources for this page

Verify at the official NPI Registry.