NPIMap

Individual provider Active NPI

Ketankumar N Vaidya, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Edison, NJ
National Provider Identifier
1487688586
Registry record updated Mar 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
MA74514 Issued in NJ
Practice address
2149 Woodbridge Ave
Edison, NJ 08817-4474
Phone
(732) 985-2151
Fax
(732) 985-0650
NPI assigned
Jul 11, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X MA74514 NJ Primary

Addresses

Primary practice location

2149 Woodbridge Ave
Edison, NJ 08817-4474

Mailing address

2149 Woodbridge Ave
Edison, NJ 08817-4474
Phone (732) 985-2151

Other identifiers 1

IdentifierTypeStateIssuer
9002707MedicaidNJ

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
I20040712000554 NJ Practitioner - Internal MedicinePractitioner - Geriatric Medicine 1850379280 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2149 Woodbridge Ave
Edison, NJ 08817-4474
Phone (732) 985-2151

Hospital & facility affiliations

  • Hackensack Meridian JFK at Home Home health agency, Iselin, NJ, CCN 317059
  • Bayada Home Health Care, Inc. Home health agency, Cranford, NJ, CCN 317020
  • Robert Wood Johnson Visiting Nurses, Inc Home health agency, North Brunswick, NJ, CCN 317079
  • Community Visiting Nurse Service Home health agency, Somerville, NJ, CCN 317023
  • Serenity Hospice Care Hospice, Trenton, NJ, CCN 311574
  • Raritan Bay Medical Center Hospital, Perth Amboy, NJ, CCN 310039
  • JFK University Medical Center Hospital, Edison, NJ, CCN 310108
  • Saint Peter'S University Hospital Hospital, New Brunswick, NJ, CCN 310070
  • Brighton Gardens of Edison Nursing home, Edison, NJ, CCN 315351
  • Aristacare at Cedar Oaks Nursing home, South Plainfield, NJ, CCN 315214

Merit-based Incentive Payment System (MIPS)

Final score
96.09 of 100Reported as apm
Quality
86.89
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA74514NJMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ketankumar Vaidya, LLC Geriatric Medicine CurrentSince May 31, 2004 Accepting new patients
HMH Hospitals Corporation Past Accepting new patients
Tara P. Kanetkar, MD, PA PastSince May 31, 2004 Accepting new patients
Robert Wood Johnson University Hospital, Inc Past Accepting new patients
Flushing Hospital & Medical Center Past Accepting new patients

Locations

2149 Woodbridge Ave
Edison, NJ 08817
Phone (732) 985-2151

Interoperability endpoints

  • Direct secure messaging: ketankumar.vaidya@glacecentral.com

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Brighton Gardens of EdisonEdison, NJ, CCN 315351 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Mar 1, 2013
Mar 1, 2013

Owned or controlled facilities with NPI records 1

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

Organizations & group practices 5

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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1487688586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2149 WOODBRIDGE AVE",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088174474",
            "telephone_number": "732-985-2151",
            "fax_number": "732-985-0650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2149 WOODBRIDGE AVE",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088174474",
            "telephone_number": "732-985-2151",
            "fax_number": "732-985-0650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAIDYA",
        "first_name": "KETANKUMAR",
        "middle_name": "N",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "MA74514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9002707",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edison, NJ

Sources for this page

Verify at the official NPI Registry.