NPIMap

Individual provider Active NPI

Shoshana Bacon, M.D.

  • Internal Medicine Physician
  • Lakewood, NJ
National Provider Identifier
1457791428
Registry record updated Jun 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA09955000 Issued in NJ
Practice address
1771 Madison Avenue
Lakewood, NJ 08701
Phone
(732) 364-2144
Fax
(732) 364-3559
NPI assigned
Jul 5, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 25MA09955000 NJ Primary

Addresses

Primary practice location

1771 Madison Avenue
Lakewood, NJ 08701

Mailing address

1771 Madison Avenue
Lakewood, NJ 08701
Phone (732) 364-2144

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
I20161022000035 NJ Practitioner - Internal Medicine 2163700378 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Plover Inpatient Services LLCGroup PAC ID 1355561663, 158 clinicians
Lakewood Resource and Referral Center IncGroup PAC ID 6901981497, 106 clinicians

Practice addresses (Care Compare)

1 Bay Ave
Montclair, NJ 07042-4837
Phone (973) 429-6000

1771 Madison Ave
Lakewood, NJ 08701-1242
Phone (732) 364-2144

Hospital & facility affiliations

  • Monmouth Medical Center-Southern Campus Hospital, Lakewood, NJ, CCN 310084
  • Centrastate Medical Center Hospital, Freehold, NJ, CCN 310111
  • Ocean Medical Center Hospital, Brick, NJ, CCN 310052
  • Jersey Shore University Medical Center Hospital, Neptune, NJ, CCN 310073

Merit-based Incentive Payment System (MIPS)

Final score
87.07 of 100Reported as group
Quality
76.5
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rwjbh Emergency Medicine Associates, LLC Internal Medicine CurrentSince May 26, 2021 Accepting new patients
Lakewood Resource and Referral Center, Inc. CurrentSince Oct 1, 2016 Accepting new patients
Lakewood Resource and Referral Center Inc CurrentSince Oct 1, 2016 Accepting new patients

Locations

225 Williamson St
Elizabeth, NJ 07202
Phone (908) 994-5204

1771 Madison Ave
Lakewood, NJ 08701
Phone (732) 364-2144

Interoperability endpoints

  • Direct secure messaging: shoshana.bacon@chemed.eclinicaldirectplus.com
  • Direct secure messaging: sbacon45789@epicdirect.rwjbh.org

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1372982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528156800000",
    "number": "1457791428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1771 MADISON AVENUE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "08701",
            "telephone_number": "732-364-2144",
            "fax_number": "732-364-3559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1771 MADISON AVENUE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "08701",
            "telephone_number": "732-364-2144",
            "fax_number": "732-364-3559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "SHOSHANA",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-05",
        "last_updated": "2018-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA09955000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, NJ

Sources for this page

Verify at the official NPI Registry.