NPIMap

Organization Active NPI

Central Jersey Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
National Provider Identifier
1710199468
Registry record updated Jan 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
23975 Issued in NJ
Legal business name
CENTRAL JERSEY MEDICAL CENTER, INC.
Practice address
80 Johnson Ave
Newark, NJ 07108-2729
Phone
(973) 623-8592
NPI assigned
May 4, 2007
Last updated
Jan 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2023

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

Authorized official

Name
Jack O'Leary
Title
Ceo
Phone
(732) 376-9333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 23975 NJ Primary

Addresses

Primary practice location

80 Johnson Ave
Newark, NJ 07108-2729

Mailing address

PO Box 1220
Perth Amboy, NJ 08862-1220
Phone (732) 376-6635

Other identifiers 5

IdentifierTypeStateIssuer
0751103MedicaidNJ
8462500MedicaidNJ
0097918MedicaidNJ
0115045MedicaidNJ
8932603MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710199468. Details of each certification follow.

  • CCN 311910 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 311910

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CENTRAL JERSEY MEDICAL CENTER-SHABAZZ
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 13, 2014
Last certification
Jun 13, 2014
Ownership / control type
For profit – partnership
Facility address
80 Johnson Avenue
Newark, NJ 07108
Related CCNs
311833

National Provider Directory

National Provider Directory

Locations

80 Johnson Ave
Newark, NJ 07108
Phone (973) 623-8592

Practitioners & affiliated clinicians

Practitioners 180

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 180

NPI Registry JSON

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674777600000",
    "number": "1710199468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1220",
            "city": "PERTH AMBOY",
            "state": "NJ",
            "postal_code": "088621220",
            "telephone_number": "732-376-6635",
            "fax_number": "732-324-5765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 JOHNSON AVE",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071082729",
            "telephone_number": "973-623-8592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL JERSEY MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A",
        "authorized_official_last_name": "O'LEARY",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "732-376-9333"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NJ",
            "license": "23975",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0751103",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8462500",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0097918",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0115045",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8932603",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

Verify at the official NPI Registry.