Rajvir Jutla, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

22DI02612900 Issued in NJ

Practice address

3 Kelly Driver Rd
Laurel Springs, NJ 08021-4823

Phone

(856) 784-5100

NPI assigned

Jun 25, 2014

Last updated

Apr 19, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rjutla579449@direct.ochin.org

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.

• Public Health Management Corporation

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1881779866
  Medicare reassignment NPD
• Public Health Management Corporation

  dba PHMC at Stenton Manor

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1053847053
  NPD
• Public Health Management Corporation

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1467776989
  NPD
• Eastern Dental of Laurel Springs, LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Laurel Springs, NJ
  • NPI 1154448744
  NPD (past)

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

{
    "created_epoch": "1403654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461024000000",
    "number": "1477968725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 KELLY DRIVER RD",
            "city": "LAUREL SPRINGS",
            "state": "NJ",
            "postal_code": "080214823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 KELLY DRIVER RD",
            "city": "LAUREL SPRINGS",
            "state": "NJ",
            "postal_code": "080214823",
            "telephone_number": "856-784-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUTLA",
        "first_name": "RAJVIR",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-25",
        "last_updated": "2016-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02612900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hope Rising Health Care LLC
• Valerie M Iadanza-Brumbach, RPH
• Ih Physician Services 2, PC (Heartland Hospice (Woodbury))
• Intuit Counseling and Wellness Services, LLC
• James a Prate LLC
• Alyssa Kalitz, DPT
• Mark S Kemenosh, DC
• Yoon Hee Kim, D.M.D
• Matthew Joseph Kobza
• Jack Franklin Krenzel, D.D.S.

• Dentist in Laurel Springs, NJ
• Providers in Laurel Springs, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.