NPIMap

Organization Active NPI

State of New Jersey Omb Centralized Payroll

  • Psychiatric Hospital
  • Trenton, NJ
National Provider Identifier
1467552240
Registry record updated May 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Practice address
101 Sullivan Way
Trenton, NJ 08628-3425
Phone
(609) 633-1562
Fax
(609) 633-8527
NPI assigned
Sep 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2015

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

Authorized official

Name
Evan Fiebusch, M.D.
Title
Psychiatrist
Phone
(609) 633-1563

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X NJ Primary

Addresses

Primary practice location

101 Sullivan Way
Trenton, NJ 08628-3425

Mailing address

101 Sullivan Way
Trenton, NJ 08628-3425
Phone (609) 633-1562

Other identifiers 1

IdentifierTypeStateIssuer
692713OtherNJMEDICARE GROUP BILLING

Other names 1

  • Trenton Psychiatric Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050603000317 NJ Part B Supplier - Clinic/Group Practice 6406742592 Receives reassigned benefits from 70 practitioners
Practice locations: Trenton, NJ
O20101201000826 NJ Part A Provider - Hospital 6406742592 Practice locations: West Trenton, NJ

Hospital certification: CCN 314013

Legal name
STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Doing business as
TRENTON PSYCHIATRIC HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Dec 8, 1976
Last certification
Nov 14, 2025
Beds
436 (350 certified)
Ownership / control type
State
Organization structure
OtherNon-profit
Incorporated
in NJ
Enrollment address
100 Sullivan Way
Trenton Psychiatric Hospital
West Trenton, NJ 86252306
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric, Other

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
Trenton Psychiatric HospCCN 314013
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Hunterdon Developmental22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

101 Sullivan Way
Ewing, NJ 08628
Phone (609) 633-1562

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Satya N Vatti Individual W-2 Managing EmployeeProgram Manager Oct 26, 2019
Jennifer Santora Individual W-2 Managing Employee May 18, 2013
James Hollen Individual Corporate Officer Nov 1, 2021
W-2 Managing Employee Nov 1, 2021
Towana Wilkins Individual W-2 Managing Employee Dec 1, 2019
Intikhab Ahmad Individual Corporate Director Jan 1, 2019
W-2 Managing Employee Jan 1, 2019

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
New Jersey Veterans Memorial Home at ParamusParamus, NJ, CCN 315346 Skilled nursing facility Operational/Managerial Control
Other		 Jul 1, 1995
Jul 1, 1995

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 113

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 113

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430870400000",
    "number": "1467552240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SULLIVAN WAY",
            "city": "TRENTON",
            "state": "NJ",
            "postal_code": "086283425",
            "telephone_number": "609-633-1562",
            "fax_number": "609-633-8527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SULLIVAN WAY",
            "city": "TRENTON",
            "state": "NJ",
            "postal_code": "086283425",
            "telephone_number": "609-633-1562",
            "fax_number": "609-633-8527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2015-05-06",
        "status": "A",
        "authorized_official_last_name": "FIEBUSCH",
        "authorized_official_first_name": "EVAN",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "609-633-1563",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP BILLING",
            "identifier": "692713",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trenton Psychiatric Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Trenton, NJ

Sources for this page

Verify at the official NPI Registry.