NPIMap

Organization Active NPI

Shore Memorial Hospital

Doing business as SMH Professional Services

  • Hematology & Oncology Physician
  • Somers Point, NJ
National Provider Identifier
1689795338
Registry record updated May 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
MB052916 Issued in NJ
Legal business name
SHORE MEMORIAL HOSPITAL
Doing business as
SMH Professional Services
Practice address
1 East New York Ave
Somers Point, NJ 08244-2340
Phone
(609) 653-3213
Fax
(609) 653-3942
NPI assigned
Apr 2, 2007
Last updated
May 30, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
SHORE MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 30, 2014

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

Authorized official

Name
Mr. Ronald W. Johnson
Title
President and Ceo
Phone
(609) 653-3545

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X MA65533 NJ
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X NJ
NutritionistGroup: 193200000X MULTI-SPECIALTY GROUP 133N00000X MA65533 NJ
Critical Care Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0200X 25MA04612900 NJ
Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0003X MB052916 NJ Primary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X 25MA04612900 NJ
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X MA65533 NJ
Neonatal-Perinatal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080N0001X MA65533 NJ
Neonatal-Perinatal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080N0001X NJ
Radiation Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0001X 25MA08489700 NJ

Addresses

Primary practice location

1 East New York Ave
Somers Point, NJ 08244-2340

Mailing address

1 East New York Ave
Somers Point, NJ 08244-2340
Phone (609) 653-3213

Other names 1

  • SMH Professional Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080128000527 NJ Part B Supplier - Clinic/Group Practice 1052493202 Receives reassigned benefits from 38 practitioners
Practice locations: Somers Point, 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
Shore Memorial Hospital5 organizations share this tax ID, including this one
Part of
Shore Memorial Hospital

Other organizations with this tax ID 4

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

Locations

501 Zion Rd
Egg Harbor Twp, NJ 08234
Phone (609) 927-8069

914 Haven Ave
Ocean City, NJ 08226
Phone (609) 391-8105

100 Medical Center Way
Somers Point, NJ 08244
Phone (609) 272-0506

415 Shore Rd
Somers Point, NJ 08244
Phone (609) 653-3711

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Shore Medical CenterSomers Point, NJ, CCN 310047 Hospital Operational/Managerial Control Aug 16, 2002

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 50

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.

View all 50

NPI Registry JSON

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401408000000",
    "number": "1689795338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EAST NEW YORK AVE",
            "city": "SOMERS POINT",
            "state": "NJ",
            "postal_code": "082442340",
            "telephone_number": "609-653-3213",
            "fax_number": "609-653-3942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 EAST NEW YORK AVE",
            "city": "SOMERS POINT",
            "state": "NJ",
            "postal_code": "082442340",
            "telephone_number": "609-653-3213",
            "fax_number": "609-653-3942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHORE MEMORIAL HOSPITAL",
        "enumeration_date": "2007-04-02",
        "last_updated": "2014-05-30",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "609-653-3545",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "NJ",
            "license": "MA65533",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": "NJ",
            "license": "MA65533",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NJ",
            "license": "25MA04612900",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NJ",
            "license": "MB052916",
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NJ",
            "license": "25MA04612900",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "NJ",
            "license": "MA65533",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NJ",
            "license": "MA65533",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": "NJ",
            "license": "25MA08489700",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMH Professional Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Somers Point, NJ

Sources for this page

Verify at the official NPI Registry.