NPIMap

Organization Active NPI

Njcri Physicians Group PC

  • Internal Medicine Physician
  • Newark, NJ
National Provider Identifier
1487100657
Registry record updated Apr 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA05479500 Issued in NJ
Legal business name
NJCRI PHYSICIANS GROUP PC
Practice address
393 Central Ave
Newark, NJ 07103-2842
Phone
(973) 483-3444
Fax
(347) 342-0769
NPI assigned
Aug 29, 2016
Organization subpart
Yes
Parent organization
NORTH JERSEY COMMUNITY RESEARCH INITIATIVEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 12, 2017

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

Authorized official

Name
Mr. Shawn Ekwall, MBA
Title
Administrator
Phone
(973) 483-3444

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 25MA05479500 NJ Primary

Addresses

Primary practice location

393 Central Ave
Newark, NJ 07103-2842

Mailing address

393 Central Ave
Newark, NJ 07103-2842
Phone (973) 483-3444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170327002115 NJ Part B Supplier - Clinic/Group Practice 4587949961 Receives reassigned benefits from 8 practitioners
Practice locations: Newark, NJ

National Provider Directory

National Provider Directory
Part of
N Jersey Comm Research Init

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19575/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1472428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491955200000",
    "number": "1487100657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 CENTRAL AVE",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032842",
            "telephone_number": "973-483-3444",
            "fax_number": "347-342-0769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "393 CENTRAL AVE",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032842",
            "telephone_number": "973-483-3444",
            "fax_number": "347-342-0769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NJCRI PHYSICIANS GROUP PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH JERSEY COMMUNITY RESEARCH INITIATIVE",
        "enumeration_date": "2016-08-29",
        "last_updated": "2017-04-12",
        "status": "A",
        "authorized_official_last_name": "EKWALL",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "973-483-3444",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA05479500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.