NPIMap

Individual provider Active NPI

Wamiq Sultan, MD

  • Nephrology Physician
  • Garnet Valley, PA
National Provider Identifier
1699873463
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MA63364 Issued in NJ
Practice address
3241 Sarum Farm LN
Garnet Valley, PA 19060-2258
Phone
(856) 887-3005
Fax
(856) 759-4035
NPI assigned
Sep 20, 2006
Last updated
Oct 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MA63364 NJ
Internal Medicine Physician 207R00000X MD-056420-L PA
Nephrology Physician 207RN0300X MD-056420-L PA
Nephrology Physician 207RN0300X MA63364 NJ Primary

Addresses

Primary practice location

3241 Sarum Farm LN
Garnet Valley, PA 19060-2258

Mailing address

3241 Sarum Farm LN
Garnet Valley, PA 19060-2258
Phone (856) 887-3005

Other identifiers 14

IdentifierTypeStateIssuer
223266219 041OtherNJTRICARE CHAMPUS
3364422OtherNJCIGNA HEALTHCARE
3K6114OtherNJHEALTHNET, INC
1839600OtherNJUNITED HEALTHCARE
19789OtherNJUNIVERSITY HEALTH PLAN
356685OtherPAPENNSYLVANIA BLUE SHIELD
SA0000055OtherNJAMERICHOICE
0595807OtherNJAETNA US HEALTHCARE
P1273820OtherNJOXFORD HEALTH CARE
130018460OtherNJRAILROAD MEDICARE
356685OtherPAAMERIHEALTH PPO PABS
1070758OtherNJHORIZON- NJ HEALTH
7516100MedicaidNJ
0663772000OtherNJAMERIHEALTH HMO

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
I20041222000678 NJ Practitioner - Internal MedicinePractitioner - Nephrology 5597723452 Reassigns benefits to 2 organizations
Practice locations: Salem, NJ

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Complete Care of South JerseyGroup PAC ID 8820389257, 8 clinicians

Practice addresses (Care Compare)

127 N Broad St
Woodbury, NJ 08096-1718
Phone (856) 887-3005

310 Woodstown Rd
Salem, NJ 08079
Phone (856) 339-6038

4 Bypass Rd
Suite 104
Salem, NJ 08079-2053
Phone (856) 887-3005

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
20.19 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
67.3

Merit-based Incentive Payment System (MIPS)

Final score
21.39 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
71.29

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA63364NJMDInternal Medicine Physician
MD-056420-LPAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Careconnectmd New Jersey PC CurrentSince Jan 1, 2025 Accepting new patients
Complete Care of South Jersey Nephrology CurrentSince Jul 1, 2016 Accepting new patients
Gardens Operator LLC Past Accepting new patients
Inspira Medical Centers, Inc. Past Accepting new patients
Cumberland Operator LLC Past Accepting new patients
Inspira Medical Centers, Inc. Past Accepting new patients
Tri State Nephrologists LLC Nephrology Past Accepting new patients
WS Healthcare Past Accepting new patients
American Health Corporation and Subsidiaries Past Accepting new patients
Carneys Point Rehabilitation and Nursing Center LLC Past Accepting new patients

Locations

3090 Bristol St
Ste 200
Costa Mesa, CA 92626
Phone (714) 992-1182

101 Eisenhower Pkwy
Ste 300
Roseland, NJ 07068
Phone (201) 520-7221

310 Salem Woodstown Rd
Salem, NJ 08079
Phone (856) 339-6054

4 Bypass Rd
Ste 104
Salem, NJ 08079
Phone (856) 887-3005

5 Route 45
Ste 101
Salem, NJ 08079
Phone (856) 878-1500

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
Autumn Lake Healthcare at Memorial BridgePennsgrove, NJ, CCN 315271 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2017
Jan 1, 2017

Owned or controlled facilities with NPI records 1

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

Organizations & group practices 10

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 20

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1699873463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3241 SARUM FARM LN",
            "city": "GARNET VALLEY",
            "state": "PA",
            "postal_code": "190602258",
            "telephone_number": "856-887-3005",
            "fax_number": "856-759-4035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3241 SARUM FARM LN",
            "city": "GARNET VALLEY",
            "state": "PA",
            "postal_code": "190602258",
            "telephone_number": "856-887-3005",
            "fax_number": "856-759-4035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULTAN",
        "first_name": "WAMIQ",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MA63364",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD-056420-L",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "PA",
            "license": "MD-056420-L",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NJ",
            "license": "MA63364",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE CHAMPUS",
            "identifier": "223266219 041",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HEALTHCARE",
            "identifier": "3364422",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET, INC",
            "identifier": "3K6114",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1839600",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERSITY HEALTH PLAN",
            "identifier": "19789",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENNSYLVANIA BLUE SHIELD",
            "identifier": "356685",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICHOICE",
            "identifier": "SA0000055",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "0595807",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH CARE",
            "identifier": "P1273820",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "130018460",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH PPO PABS",
            "identifier": "356685",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON- NJ HEALTH",
            "identifier": "1070758",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7516100",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH HMO",
            "identifier": "0663772000",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garnet Valley, PA

Sources for this page

Verify at the official NPI Registry.