NPIMap

Organization Active NPI

The Estaugh T/a Medford Leas

  • Geriatric Medicine (Family Medicine) Physician
  • Medford, NJ
National Provider Identifier
1659309524
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
THE ESTAUGH T/A MEDFORD LEAS
Practice address
1 Medford Leas
Medford, NJ 08055-2254
Phone
(609) 654-3005
Fax
(609) 654-7894
NPI assigned
Jun 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

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

Authorized official

Name
Mr. Jeremy M Vickers
Title
Chief Executive Officer
Phone
(609) 654-3009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QG0300X Primary

Addresses

Primary practice location

1 Medford Leas
Medford, NJ 08055-2254

Mailing address

1 Medford Leas
Medford, NJ 08055-2254
Phone (609) 654-3005

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address medford.leas@mlwc.eclinicaldirectplus.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041213000560 NJ Part B Supplier - Clinic/Group Practice 6608833512 Receives reassigned benefits from 4 practitioners
Practice locations: Medford, NJ

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Medford Leas3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1659309524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDFORD LEAS",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080552254",
            "telephone_number": "609-654-3005",
            "fax_number": "609-654-7894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDFORD LEAS",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080552254",
            "telephone_number": "609-654-3005",
            "fax_number": "609-654-7894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE ESTAUGH T/A MEDFORD LEAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A",
        "authorized_official_last_name": "VICKERS",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "609-654-3009",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medford.leas@mlwc.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "direct messaging address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1 Medford Leas",
            "city": "Medford",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080552254",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Medford, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; 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.