NPIMap

Individual provider Active NPI

Maged T Boutros, M.D.

  • Internal Medicine Physician
  • Clifton, NJ
National Provider Identifier
1497785281
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA08097300 Issued in NJ
Practice address
1033 Route 46 Ste G1
Clifton, NJ 07013-2448
Phone
(973) 429-6000
NPI assigned
Jul 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA08097300 NJ Primary

Addresses

Primary practice location

1033 Route 46 Ste G1
Clifton, NJ 07013-2448

Mailing address

1033 Route 46 East
Suite G1
Clifton, NJ 07013
Phone (973) 777-3711

Other identifiers 4

IdentifierTypeStateIssuer
0138808OtherNJGHI
0111759MedicaidNJ
P00688848OtherNJRAILROAD MEDICARE-HIGHLAND PHYS SRVS
P00359479OtherNJRAILROAD

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
I20060911000083 NJ Practitioner - Internal Medicine 7214931005 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prevention Clinics LLCGroup PAC ID 3173830445, 4 clinicians

Practice addresses (Care Compare)

1033 Route 46
Suite G3
Clifton, NJ 07013-2473
Phone (973) 777-3711

Hospital & facility affiliations

  • Valley Home Care Inc. Home health agency, Paramus, NJ, CCN 317008
  • Amedisys Home Health Home health agency, Hackensack, NJ, CCN 317047
  • Hackensack Meridian Mountainside Medical Hospital, Montclair, NJ, CCN 310054
  • Hackensack University Medical Center Hospital, Hackensack, NJ, CCN 310001
  • St Joseph'S University Medical Center Inc Hospital, Paterson, NJ, CCN 310019
  • Holy Name Medical Center Hospital, Teaneck, NJ, CCN 310008
  • Valley Hospital Hospital, Paramus, NJ, CCN 310012
  • Kessler Rehab Center Inpatient rehabilitation facility, West Orange, NJ, CCN 313025

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA08097300NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prevention Clinics LLC Internal Medicine CurrentSince Jul 21, 2015 Accepting new patients
Montclair Hospital LLC Past Accepting new patients
Dominick Condo MD PA Past Accepting new patients

Locations

1033 Route 46
Ste G3
Clifton, NJ 07013
Phone (973) 777-3711

1033 US Highway 46
Ste G1
Clifton, NJ 07013
Phone (973) 777-3711

57 W Pleasant Ave
Maywood, NJ 07607
Phone (201) 488-2111

1 Bay Ave
Montclair, NJ 07042
Phone (973) 429-6100

Interoperability endpoints

  • Direct secure messaging: mboutros191468@ahs.direct-ci.com
  • FHIR API: https://api.platform.athenahealth.com/18490/brand/1/csg/1/fhir/r4
  • Direct secure messaging: maged.boutros.1@18490.direct.athenahealth.com

Organizations & group practices 3

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 10

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": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1497785281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 ROUTE 46 EAST",
            "address_2": "SUITE G1",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "07013",
            "telephone_number": "973-777-3711",
            "fax_number": "973-472-3938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1033 ROUTE 46 STE G1",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070132448",
            "telephone_number": "973-429-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTROS",
        "first_name": "MAGED",
        "middle_name": "T",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA08097300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "0138808",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0111759",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE-HIGHLAND PHYS SRVS",
            "identifier": "P00688848",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00359479",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clifton, NJ

Sources for this page

Verify at the official NPI Registry.