NPIMap

Organization Active NPI

Prime Healthcare Services - St Michaels LLC

  • General Acute Care Hospital
  • Newark, NJ
National Provider Identifier
1568825545
Registry record updated Mar 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
10713 Issued in NJ
Legal business name
PRIME HEALTHCARE SERVICES - ST MICHAELS LLC
Practice address
111 Central Ave
Newark, NJ 07102-1909
Phone
(973) 877-2853
Fax
(973) 877-5367
NPI assigned
Mar 29, 2016
Last updated
Mar 29, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2016

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

Authorized official

Name
Christopher Doan
Title
Chief Compliance Counsel
Phone
(909) 235-4307

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 10713 NJ
Psychiatric Hospital Unit 273R00000X 10713 NJ
General Acute Care Hospital 282N00000X 10713 NJ Primary

Addresses

Primary practice location

111 Central Ave
Newark, NJ 07102-1909

Mailing address

111 Central Ave
Newark, NJ 07102-1909
Phone (973) 877-2853

Other identifiers 1

IdentifierTypeStateIssuer
4140508MedicaidNJ

Other names 1

  • Saint Michael's Medical Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160720001094 NJ Part A Provider - Hospital 0244523884 Practice locations: Newark, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568825545. Details of each certification follow.

Hospital certification: CCN 310096

Legal name
PRIME HEALTHCARE SERVICES - ST MICHAELS LLC
Doing business as
SAINT MICHAEL'S MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Sep 21, 2023
Beds
358
Ownership / control type
Private (not for profit)
Most recent change of ownership
May 1, 2016 (4 total)
Organization structure
LLCProprietary
Incorporated
Jan 14, 2013 in DE
Enrollment address
111 Central Ave
Newark, NJ 71021909
Other Hospital Practice Location
Hospital subgroups
General

Care Compare: Hospital

Medicare Care Compare
Listed as
Saint Michael's Medical CenterCCN 310096 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Prime Healthcare Services - St Michaels LLC Organization, Ontario, CA Created for acquisition, LLC 5% Or Greater Direct Ownership Interest May 1, 2016 100%
Alan D Sickles Individual Corporate OfficerChief Executive Officer Sep 1, 2020
Corporate DirectorDirector Sep 1, 2020
W-2 Managing EmployeeChief Executive Officer Sep 1, 2020
Prime Healthcare Services, Inc Organization, Ontario, CA Corporation, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2015 100%
Steven Aleman Individual OtherChief Financial Officer Jun 1, 2020
Christopher Doan Individual Corporate OfficerChief Compliance Counsel Jul 1, 2017

Facilities with the same owner 75

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 75

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

Affiliated clinicians 156

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 156

NPI Registry JSON

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

{
    "created_epoch": "1459209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459209600000",
    "number": "1568825545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 CENTRAL AVE",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071021909",
            "telephone_number": "973-877-2853",
            "fax_number": "973-877-5367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 CENTRAL AVE",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071021909",
            "telephone_number": "973-877-2853",
            "fax_number": "973-877-5367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE SERVICES - ST MICHAELS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-29",
        "last_updated": "2016-03-29",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE COUNSEL",
        "authorized_official_telephone_number": "909-235-4307"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NJ",
            "license": "10713",
            "primary": false
        },
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NJ",
            "license": "10713",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NJ",
            "license": "10713",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4140508",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saint Michael's Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Newark, NJ

Sources for this page

Verify at the official NPI Registry.