Organization Active NPI

Ambulatory Care Center PA

  • Ambulatory Surgical Clinic/Center
  • Vineland, NJ
National Provider Identifier
1528024114
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
AMBULATORY CARE CENTER PA
Practice address
1133 East Chestnut Ave.
Vineland, NJ 08360
Phone
(856) 507-0800
Fax
(856) 507-0824
NPI assigned
Apr 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

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

Authorized official

Name
Melissa Ritter Hermanson
Title
Administrator
Phone
(856) 507-0800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 22422 NJ
Ambulatory Surgical Clinic/Center 261QA1903X NJ Primary

Addresses

Primary practice location

1133 East Chestnut Ave.
Vineland, NJ 08360

Mailing address

1133 East Chestnut Ave.
Vineland, NJ 08360
Phone (856) 507-0800

Other identifiers 1

IdentifierTypeStateIssuer
7594305MedicaidNJ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100308000550 NJ Part B Supplier - Ambulatory Surgical Center 2264577881 Practice locations: Vineland, NJ

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Ambulatory Care CenterCCN 31C0001100
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D1051980Ambulatory Care Center1133 East Chestnut Avenue, Vineland, NJ 08360Certificate of waiverMar 14, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1145836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687392000000",
    "number": "1528024114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 EAST CHESTNUT AVE.",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "08360",
            "telephone_number": "856-507-0800",
            "fax_number": "856-507-0824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 EAST CHESTNUT AVE.",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "08360",
            "telephone_number": "856-507-0800",
            "fax_number": "856-507-0824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMBULATORY CARE CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-24",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A",
        "authorized_official_last_name": "HERMANSON",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "RITTER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "856-507-0800"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NJ",
            "license": "22422",
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7594305",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineland, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.