Individual provider Active NPI

Jacqueline Marie Wyka Mahajan, PSYD

  • Cognitive & Behavioral Psychologist
  • Berkeley Heights, NJ
National Provider Identifier
1609268168
Registry record updated Feb 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X
License
35SI00542100 Issued in NJ
Practice address
654 Springfield Ave
Berkeley Heights, NJ 07922-1078
Phone
(908) 277-8900
NPI assigned
Feb 20, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral Psychologist 103TB0200X 35SI00542100 NJ Primary
Clinical Psychologist 103TC0700X 35SI00542100 NJ

Addresses

Primary practice location

654 Springfield Ave
Berkeley Heights, NJ 07922-1078

Mailing address

654 Springfield Ave
Berkeley Heights, NJ 07922-1078

Other names 1

  • Dr. Jacqueline M. Wyka Professional name

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150424000492 NJ Practitioner - Clinical Psychologist 2466771464 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Summit Medical Group PAGroup PAC ID 5395642276, 1,204 clinicians

Practice addresses (Care Compare)

1 Diamond Hill Rd
Berkeley Heights, NJ 07922-2104
Phone (908) 273-4300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group PA CurrentSince Mar 16, 2015 Accepting new patients
Summit Medical Group PA CurrentSince Mar 16, 2015 Accepting new patients
Summit Medical Group, Inc Past Accepting new patients

Locations

1 Diamond Hill Rd
Berkeley Heights, NJ 07922
Phone (908) 277-8868

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: jacqueline.wyka.mahajan.1@16585.direct.athenahealth.com
  • Direct secure messaging: jacqueline.wykamahajan.1@2983.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.

NPI Registry JSON

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

{
    "created_epoch": "1424390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424390400000",
    "number": "1609268168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "654 SPRINGFIELD AVE",
            "city": "BERKELEY HEIGHTS",
            "state": "NJ",
            "postal_code": "079221078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "654 SPRINGFIELD AVE",
            "city": "BERKELEY HEIGHTS",
            "state": "NJ",
            "postal_code": "079221078",
            "telephone_number": "908-277-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYKA MAHAJAN",
        "first_name": "JACQUELINE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-20",
        "last_updated": "2015-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NJ",
            "license": "35SI00542100",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35SI00542100",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "WYKA",
            "middle_name": "M.",
            "prefix": "DR.",
            "credential": "PSYD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Berkeley Heights, NJ

Sources for this page

Verify at the official NPI Registry.