NPIMap

Individual provider Active NPI

Justin Brackenrich, D.O

  • Internal Medicine Physician
  • North Bergen, NJ
National Provider Identifier
1669852729
Registry record updated Apr 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MB10252300 Issued in NJ
Practice address
7600 River Rd
North Bergen, NJ 07047-6217
Phone
(201) 854-5000
NPI assigned
Jun 4, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 18, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 25MB10252300 NJ Primary

Addresses

Primary practice location

7600 River Rd
North Bergen, NJ 07047-6217

Mailing address

7600 River Rd
North Bergen, NJ 07047-6217
Phone (201) 854-5000

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
I20180613000495 NJ Practitioner - Family Practice 4981959053 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Optum Medical Care of New Jersey PCGroup PAC ID 3072650290, 168 clinicians

Practice addresses (Care Compare)

935 River Rd
Suite 301
Edgewater, NJ 07020-2233
Phone (201) 471-7012

Hospital & facility affiliations

  • Hackensack University Medical Center Hospital, Hackensack, NJ, CCN 310001
  • Palisades Medical Center Hospital, North Bergen, NJ, CCN 310003

Merit-based Incentive Payment System (MIPS)

Final score
85.15 of 100Reported as group
Quality
71.59
Promoting interoperability
100
Improvement activities
40
Cost
76.65

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care of New Jersey PC Internal Medicine CurrentSince Jun 1, 2018 Accepting new patients
Optum Medical Care of New Jersey PC CurrentSince Jun 1, 2018 Accepting new patients
Riverside Medical Group Past Accepting new patients
HMH Hospitals Corporation Past Accepting new patients

Locations

935 River Rd
Ste 301
Edgewater, NJ 07020
Phone (201) 471-7012

1 Maywood Ave
Maywood, NJ 07607
Phone (201) 464-4772

200 Main St
Ridgefield Park, NJ 07660
Phone (201) 863-3346

38 Meadowlands Pkwy
Ste 205
Secaucus, NJ 07094
Phone (201) 552-2357

3403 S Delsea Dr
Vineland, NJ 08360
Phone (856) 293-6974

Interoperability endpoints

  • Direct secure messaging: jbrackenrich77150@direct.optum.com

Organizations & group practices 4

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 4

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": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555545600000",
    "number": "1669852729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7600 RIVER RD",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070476217",
            "telephone_number": "201-854-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 RIVER RD",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070476217",
            "telephone_number": "201-854-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACKENRICH",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-04",
        "last_updated": "2019-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MB10252300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Bergen, NJ

Sources for this page

Verify at the official NPI Registry.