Individual provider Active NPI

Premilla Mendonca, APN-C

  • Gerontology Nurse Practitioner
  • Edison, NJ
National Provider Identifier
1619417300
Registry record updated Oct 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
26NJ00636900 Issued in NJ
Practice address
73 Karen PL
Edison, NJ 08817-2352
Phone
(732) 331-8947
NPI assigned
Mar 1, 2017
Last updated
Oct 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 26NJ00636900 NJ Primary

Addresses

Primary practice location

73 Karen PL
Edison, NJ 08817-2352

Mailing address

73 Karen PL
Edison, NJ 08817-2352
Phone (732) 331-8947

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220823003408 NJ Practitioner - Nurse Practitioner 4486037496 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Rutgers New Jersey Medical School, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

195 Little Albany St
Suite 1100
New Brunswick, NJ 08901-1914
Phone (732) 235-2465

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rutgers Health-RWJ Scleroderma Program CurrentSince Jul 8, 2024 Accepting new patients
Rutgers Health-RWJ Scleroderma Program CurrentSince Jul 8, 2024 Accepting new patients
Rutgers Health-RWJ Scleroderma Program Current Accepting new patients
Rutgers Health-RWJ Scleroderma Program Current Accepting new patients
Rutgers Health-RWJ Primary Medicine Group Current Accepting new patients

Locations

125 Paterson St
Ste 5100
New Brunswick, NJ 08901
Phone (732) 235-7060

125 Paterson St
Ste 6100
New Brunswick, NJ 08901
Phone (732) 235-6561

195 Little Albany St
Ste 1100
New Brunswick, NJ 08901
Phone (732) 235-2465

Interoperability endpoints

  • Direct secure messaging: pmendonca411786@epicdirect.rwjbh.org

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 1

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": "1488326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1619417300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73 KAREN PL",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088172352",
            "telephone_number": "732-331-8947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73 KAREN PL",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088172352",
            "telephone_number": "732-331-8947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDONCA",
        "first_name": "PREMILLA",
        "name_prefix": "Mrs.",
        "credential": "APN-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-01",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NJ",
            "license": "26NJ00636900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edison, NJ

Sources for this page

Verify at the official NPI Registry.