NPIMap

Organization Active NPI

Rutgers RWJ Eric B. Chandler Health Center

  • Federally Qualified Health Center (FQHC)
  • New Brunswick, NJ
National Provider Identifier
1619916574
Registry record updated Jul 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
24001 Issued in NJ
Legal business name
RUTGERS RWJ ERIC B. CHANDLER HEALTH CENTER
Practice address
123 Church St
New Brunswick, NJ 08901-2001
Phone
(732) 235-6700
Fax
(732) 235-6726
NPI assigned
Jun 6, 2006
Last updated
Jul 2, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
RUTGERS THE STATE UNIVERSITY OF NEW JERSEYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 2, 2013

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

Authorized official

Name
Sandra Adams
Title
Interim Executive Director
Phone
(732) 235-6756

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 24001 NJ Primary

Addresses

Primary practice location

123 Church St
New Brunswick, NJ 08901-2001

Mailing address

277 George St
New Brunswick, NJ 08901-1311
Phone (732) 235-6700

Other identifiers 1

IdentifierTypeStateIssuer
0101184MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040116000249 NJ Part B Supplier - Clinic/Group Practice 0042111601 Receives reassigned benefits from 38 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New Brunswick, NJ
O20061012000687 NJ Part A Provider - Federally Qualified Health Center (FQHC) 0042111601 Practice locations: New Brunswick, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619916574. Details of each certification follow.

Federally qualified health center certification: CCN 311867

Legal name
RUTGERS RWJ ERIC B. CHANDLER HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 22, 2006
Last certification
Nov 22, 2006
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
123 Church St
New Brunswick, NJ 89012001

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D1050468Eric B Chandler Health Center123 Church Street, New Brunswick, NJ 08901Certificate of waiverFeb 2, 2028

National Provider Directory

National Provider Directory
Part of
Robert Wood Johnson Medical School

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Sean Hewitt Individual Operational/Managerial ControlCommunity Board Vice Chairperson Jul 1, 2013
Rutgers the State University of New Jersey Organization, Piscataway, NJ 5% Or Greater Direct Ownership Interest Jul 1, 2013 100%
Joseph Perez Individual Operational/Managerial ControlCommunity Board Member Treasurer Jul 1, 2013
Edith Brown Individual Operational/Managerial ControlCommunity Board Member Jul 1, 2013
Sandra T Hill Individual Corporate DirectorExecutive Director May 28, 2007 100%
W-2 Managing EmployeeExecutive Director May 28, 2007 100%
Rose Flowers Individual Operational/Managerial ControlCommunity Board Member Jul 1, 2013
Hiwot Bekele Individual W-2 Managing EmployeeAd;Director of Finance Jul 7, 2025
Susan Jackson Individual Operational/Managerial ControlCommunity Board Secretary Jul 1, 2013
Lauren Moore-Carrington Individual Operational/Managerial ControlComminty Board Chairperson Jul 1, 2013

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372723200000",
    "number": "1619916574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 GEORGE ST",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089011311",
            "telephone_number": "732-235-6700",
            "fax_number": "732-235-6726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 CHURCH ST",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089012001",
            "telephone_number": "732-235-6700",
            "fax_number": "732-235-6726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUTGERS RWJ ERIC B. CHANDLER HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RUTGERS THE STATE UNIVERSITY OF NEW JERSEY",
        "enumeration_date": "2006-06-06",
        "last_updated": "2013-07-02",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "INTERIM EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "732-235-6756"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NJ",
            "license": "24001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0101184",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Brunswick, NJ

Sources for this page

Verify at the official NPI Registry.