NPIMap

Individual provider Active NPI

Edward R Prins, MD

  • Internal Medicine Physician
  • Hackensack, NJ
National Provider Identifier
1619978905
Registry record updated Nov 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MA042916 Issued in NJ
Practice address
5 Summit Ave
Hackensack, NJ 07601
Phone
(201) 646-0001
Fax
(201) 646-9101
NPI assigned
Aug 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MA042916 NJ Primary

Addresses

Primary practice location

5 Summit Ave
Hackensack, NJ 07601

Mailing address

5 Summit Ave
Hackensack, NJ 07601
Phone (201) 646-0001

Other identifiers 6

IdentifierTypeStateIssuer
0004213156OtherAETNA US HEALTHCARE
110131307OtherRAILROAD MEDICARE
0109911000OtherAMERIHEALTH
BP105OtherOXFORD HEALTH PLANS
527245OtherMEDICARE GROUP PROVIDER
80631OtherAMERIGROUP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110613000229 NJ Practitioner - Internal Medicine 0446316053 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rutgers New Jersey Medical School, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Avenue Medical PAGroup PAC ID 2860580628, 3 clinicians

Practice addresses (Care Compare)

5 Summit Ave
Suite 101
Hackensack, NJ 07601-1271
Phone (201) 646-0001

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA042916NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Avenue Medical PA Internal Medicine CurrentSince Nov 2, 1989 Accepting new patients

Locations

5 Summit Ave
Ste 101
Hackensack, NJ 07601
Phone (201) 488-5366

Interoperability endpoints

  • Direct secure messaging: prins.edward.001.0300053@sam.meditab.direct-ci.com

Organizations & group practices 1

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.

Hospital & facility affiliations 8

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": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289779200000",
    "number": "1619978905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 SUMMIT AVE",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "07601",
            "telephone_number": "201-646-0001",
            "fax_number": "201-646-9101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 SUMMIT AVE",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "07601",
            "telephone_number": "201-646-0001",
            "fax_number": "201-646-9101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRINS",
        "first_name": "EDWARD",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2010-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MA042916",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "0004213156",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110131307",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "0109911000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH PLANS",
            "identifier": "BP105",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PROVIDER",
            "identifier": "527245",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "80631",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

Verify at the official NPI Registry.