Individual provider Active NPI

Punitha Shivaprasad, D.O

  • Gastroenterology Physician
  • Cherry Hill, NJ
National Provider Identifier
1609111699
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
25MB09222600 Issued in NJ
Practice address
1945 Marlton Pike E Ste D
Cherry Hill, NJ 08003-2160
Phone
(856) 237-8045
Fax
(856) 237-8047
NPI assigned
Dec 3, 2012
Last updated
May 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 036.145264 IL
Gastroenterology Physician 207RG0100X 25MB09222600 NJ Primary

Addresses

Primary practice location

1945 Marlton Pike E Ste D
Cherry Hill, NJ 08003-2160

Mailing address

301 Lippincott Dr Ste 410
Marlton, NJ 08053-4197
Phone (856) 355-0340

Other practice location 1

2601 W Main St
Carbondale, IL 62901-1031
Phone (618) 351-7300

Other practice location 2

404 Lincoln Dr
Herrin, IL 62948
Phone (618) 993-0056

Other identifiers 3

IdentifierTypeStateIssuer
0480789MedicaidNJ
1609111699OtherNJAETNA
1609111699OtherNJHORIZON

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address pshivaprasad112452@directvirtua.org
Direct Messaging Address pshivaprasad112452@directvirtua.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150804005500 NJ Practitioner - Gastroenterology 4385863505 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
University of New England, College of Osteo Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians
Premier Gastroenterology of HamiltonGroup PAC ID 5991042277, 2 clinicians

Practice addresses (Care Compare)

100 Bowman Dr
Voorhees, NJ 08043-9612
Phone (856) 247-7260

1600 Haddon Ave
Camden, NJ 08103-3101

1945 Route 70 E
Cherry Hill, NJ 08003-2160

2271 Route 33
Suite 110
Hamilton, NJ 08690-1749
Phone (609) 917-9917

3242 Route 206
Bordentown, NJ 08505-4517

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.15 of 100Reported as group
Quality
62.28
Promoting interoperability
100
Improvement activities
40
Cost
74.89

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy60
Upper gastrointestinal (GI) endoscopy for acid reflux273

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Gastroenterology of Hamilton Gastroenterology CurrentSince Apr 15, 2020 Accepting new patients
Gastroenterology Associates of New Jersey, LLC Gastroenterology CurrentSince Oct 1, 2023 Accepting new patients
Virtua Medical Group, PA Gastroenterology CurrentSince Mar 1, 2020 Accepting new patients
Virtua Medical Group, PA CurrentSince Mar 15, 2020 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

1601 Haddon Ave
Ste A2
Camden, NJ 08103

1945 Route 70 E
Ste D
Cherry Hill, NJ 08003

301 Lippincott Dr
Ste 410
Marlton, NJ 08053

601 Route 73 N
Ste 101
Marlton, NJ 08053
Phone (856) 355-7130

301 Lakehurst Rd
Toms River, NJ 08755
Phone (732) 281-1590

2271 State Highway 33
Ste 110
Trenton, NJ 08690
Phone (609) 586-0300

1130 McBride Ave
Fl 3
Woodland Park, NJ 07424
Phone (973) 785-2277

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JJIGAA
  • Direct secure messaging: pshivaprasad112452@directvirtua.org
  • Direct secure messaging: shivaprasad@hgi.gwaydirect.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1354492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748304000000",
    "number": "1609111699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LIPPINCOTT DR STE 410",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534197",
            "telephone_number": "856-355-0340",
            "fax_number": "856-355-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1945 MARLTON PIKE E STE D",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080032160",
            "telephone_number": "856-237-8045",
            "fax_number": "856-237-8047"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2601 W Main St",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629011031",
            "country_code": "US",
            "telephone_number": "618-351-7300",
            "fax_number": "618-457-7890",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "404 Lincoln Dr",
            "address_purpose": "LOCATION",
            "city": "Herrin",
            "state": "IL",
            "postal_code": "62948",
            "country_code": "US",
            "telephone_number": "618-993-0056",
            "fax_number": "618-993-0752",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIVAPRASAD",
        "first_name": "PUNITHA",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-03",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036.145264",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NJ",
            "license": "25MB09222600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0480789",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1609111699",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON",
            "identifier": "1609111699",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pshivaprasad112452@directvirtua.org",
            "affiliation": "N",
            "address_1": "1601 Haddon Ave Ste A2",
            "city": "Camden",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "081033109",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pshivaprasad112452@directvirtua.org",
            "affiliation": "N",
            "address_1": "1945 Marlton Pike E Ste D",
            "city": "Cherry Hill",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080032160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cherry Hill, NJ

Sources for this page

Verify at the official NPI Registry.