NPIMap

Individual provider Active NPI

Olga Kaczaj, M.D.

  • Internal Medicine Physician
  • Vineland, NJ
National Provider Identifier
1518055755
Registry record updated Nov 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MA072892 Issued in NJ
Practice address
1317 S Main Rd
Unit 2C
Vineland, NJ 08360-6511
Phone
(856) 213-6080
Fax
(856) 213-6092
NPI assigned
Oct 11, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 9, 2011

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 MA072892 NJ Primary

Addresses

Primary practice location

1317 S Main Rd
Unit 2C
Vineland, NJ 08360-6511

Mailing address

1317 S Main Rd
Unit 2C
Vineland, NJ 08360-6511
Phone (856) 213-6080

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
I20100928001203 NJ Practitioner - Internal Medicine 1557419389 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
South Main Medical Associates, LLCGroup PAC ID 3577735406, 2 clinicians

Practice addresses (Care Compare)

1317 S Main Rd
Suite 2C
Vineland, NJ 08360-6511
Phone (856) 213-6080

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA072892NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Main Medical Associates, LLC Internal Medicine CurrentSince Oct 1, 2011 Accepting new patients

Locations

1317 S Main Rd
Ste 2C
Vineland, NJ 08360
Phone (856) 213-6080

Interoperability endpoints

  • Direct secure messaging: southmainmedical@smm.azalea.phimailbox.com

Organizations & group practices 1

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 8

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": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320796800000",
    "number": "1518055755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 S MAIN RD",
            "address_2": "UNIT 2C",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083606511",
            "telephone_number": "856-213-6080",
            "fax_number": "856-213-6092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 S MAIN RD",
            "address_2": "UNIT 2C",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083606511",
            "telephone_number": "856-213-6080",
            "fax_number": "856-213-6092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KACZAJ",
        "first_name": "OLGA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2011-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MA072892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineland, NJ

Sources for this page

Verify at the official NPI Registry.