Primary Care Group LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PRIMARY CARE GROUP LLC

Practice address

2 Westfield Ave
Clark, NJ 07066-3226

Phone

(908) 505-5141

NPI assigned

Aug 5, 2019

Last updated

Aug 5, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Domenica Fantini, DONPI 1548609464

Title

Physician

Phone

(908) 505-5141

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 6

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.

• Domenica Alexandra Fantini, D.O.

  • Family Medicine Physician
  • Basking Ridge, NJ
  • NPI 1548609464
  Medicare reassignment Care Compare group NPD Authorized official
• Susan Ann Becker, APN C

  • Nurse Practitioner
  • Branchville, NJ
  • NPI 1649330135
  Medicare reassignment Care Compare group NPD
• Kinjalben Mounesh Shukla

  • Adult Health Nurse Practitioner
  • Clark, NJ
  • NPI 1306643242
  Medicare reassignment Care Compare group NPD
• Nilesh R. Patel, D.M.D.,M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Somerset, NJ
  • NPI 1740212992
  NPD (past)
• Stephen D. Sklans, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Edison, NJ
  • NPI 1477585842
  NPD (past)
• Daniel Peter Sullivan, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Warren, NJ
  • NPI 1649376468
  NPD (past)

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

{
    "created_epoch": "1564963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564963200000",
    "number": "1609421841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 WESTFIELD AVE",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070663226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 WESTFIELD AVE",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070663226",
            "telephone_number": "908-505-5141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-05",
        "last_updated": "2019-08-05",
        "status": "A",
        "authorized_official_last_name": "FANTINI",
        "authorized_official_first_name": "DOMENICA",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "908-505-5141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Dianne Pomponio, R.D.
• Lizandra M Portalatin, MA, LPC
• Porto Physical Therapy & Wellness, P.a. (Clark Performance Physical Therapy)
• Erin Melissa Power, DMD
• Sudhanshu Prasad, M.D
• Tara Prisco, PA
• Pro-Care Ambulance Services LLC
• Professional Occupational & Physical Therapy, PLLC
• Promptcare Home Infusion, Inc.
• Elizabeth Ann Prudent, FNP-BC

• Family Medicine Physician in Clark, NJ
• Providers in Clark, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.