NPIMap

Individual provider Active NPI

Kostantinos Pantelis Poulikidis, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Edison, NJ
National Provider Identifier
1689018830
Registry record updated Jan 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
25MA11659600 Issued in NJ
Practice address
80 James St
Edison, NJ 08820-3938
Phone
(732) 635-9300
NPI assigned
Apr 18, 2013
Last updated
Jan 22, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 25MA11659600 NJ Primary

Addresses

Primary practice location

80 James St
Edison, NJ 08820-3938

Mailing address

80 James St
Edison, NJ 08820-3938

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
I20230106002196 NJ Practitioner - Thoracic Surgery 9638429608 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Thoracic Surgery
Education
New York Medical College, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

102 James St
Suite 303
Edison, NJ 08820-3970
Phone (848) 205-2620

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.33 of 100Reported as group
Quality
66.38
Promoting interoperability
100
Improvement activities
40
Cost
71.39

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA11659600NJMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Dec 27, 2022 Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC Thoracic Surgery (Cardiothoracic Vascular Surgery) CurrentSince Dec 27, 2022 Accepting new patients
Hackensack Meridian Health Medical Group - Complex Care PC Past Accepting new patients

Locations

102 James St
Ste 303
Edison, NJ 08820
Phone (848) 205-2620

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

2 Hospital Plz
Ste 340
Old Bridge, NJ 08857
Phone (732) 360-3520

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD

Organizations & group practices 3

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 7

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": "1366243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769040000000",
    "number": "1689018830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 JAMES ST",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088203938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 JAMES ST",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088203938",
            "telephone_number": "732-635-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULIKIDIS",
        "first_name": "KOSTANTINOS",
        "middle_name": "PANTELIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-18",
        "last_updated": "2026-01-22",
        "certification_date": "2026-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NJ",
            "license": "25MA11659600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edison, NJ

Sources for this page

Verify at the official NPI Registry.