Individual provider Active NPI

Andre Cole, D.O.

  • Vascular Surgery Physician
  • Vineland, NJ
National Provider Identifier
1477902054
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
25MB11164600 Issued in NJ
Practice address
1206 W Sherman Ave BLDG 2a
Vineland, NJ 08360-6911
Phone
(856) 696-9933
Fax
(856) 696-9939
NPI assigned
Jun 6, 2016
Last updated
Jul 10, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 25MB11164600 NJ Primary

Addresses

Primary practice location

1206 W Sherman Ave BLDG 2a
Vineland, NJ 08360-6911

Mailing address

1206 W Sherman Ave BLDG 2a
Vineland, NJ 08360-6911
Phone (856) 696-9933

Other identifiers 1

IdentifierTypeStateIssuer
1922177856MedicaidNJ

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
I20230817000583 NJ Practitioner - Vascular SurgeryPractitioner - General Surgery 5092111740 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Surgery
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inspira Health Network Medical Group PCGroup PAC ID 4880797570, 238 clinicians

Practice addresses (Care Compare)

798 Centerton Rd
Pittsgrove, NJ 08318-3945
Phone (856) 358-6161

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)39

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Inspira Health Network Medical Group, P.C. CurrentSince Aug 1, 2023 Accepting new patients
Rowan University School of Osteopathic Medicine Past Accepting new patients

Locations

1120 Delsea Dr N
Glassboro, NJ 08028
Phone (856) 205-7071

798 Centerton Rd
Pittsgrove, NJ 08318
Phone (856) 358-6161

1206 W Sherman Ave
Bldg 1
Vineland, NJ 08360
Phone (856) 462-6250

1206 W Sherman Ave
Bldg 2
Vineland, NJ 08360
Phone (856) 696-9933

1206 W Sherman Ave
Bldg 2A
Vineland, NJ 08360
Phone (856) 692-6000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1465171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1477902054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1206 W SHERMAN AVE BLDG 2A",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083606911",
            "telephone_number": "856-696-9933",
            "fax_number": "856-696-9939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1206 W SHERMAN AVE BLDG 2A",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083606911",
            "telephone_number": "856-696-9933",
            "fax_number": "856-696-9939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLE",
        "first_name": "ANDRE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-06",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NJ",
            "license": "25MB11164600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922177856",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineland, NJ

Sources for this page

Verify at the official NPI Registry.