NPIMap

Organization Active NPI

Premier Orthopaedic of South Jersey

  • Orthopaedic Surgery Physician
  • Woodbury, NJ
National Provider Identifier
1750426151
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
MA054868 Issued in NJ
Legal business name
PREMIER ORTHOPAEDIC OF SOUTH JERSEY
Practice address
1007 Mantua Pike
Woodbury, NJ 08096-3963
Phone
(856) 853-8004
Fax
(856) 853-8022
NPI assigned
Feb 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Todd M Lipschultz, MDNPI 1124197942
Title
Dr
Phone
(856) 853-8004

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X MA054868 NJ Primary

Addresses

Primary practice location

1007 Mantua Pike
Woodbury, NJ 08096-3963

Mailing address

1007 Mantua Pike
Woodbury, NJ 08096-3963
Phone (856) 853-8004

Other identifiers 7

IdentifierTypeStateIssuer
2423391000OtherNJINDEPENDENCE BLUE CROSS
1124197942MedicaidNJ
610073OtherNJADMINISTRATORS
1271200OtherNJCIGNA
7002746OtherNJAETNA
2423391000OtherNJAMERIHEALTH
2423391000OtherNJKEYSTONE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050809000049 NJ Part B Supplier - Clinic/Group Practice 6406884717 Receives reassigned benefits from 4 practitioners
Practice locations: Marlton, NJ; West Deptford, NJ

National Provider Directory

National Provider Directory

Locations

522 Lippincott Dr
#B
Marlton, NJ 08053
Phone (856) 900-0041

1007 Mantua Pike
Ste 2
West Deptford, NJ 08096
Phone (856) 845-4601

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1750426151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 MANTUA PIKE",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080963963",
            "telephone_number": "856-853-8004",
            "fax_number": "856-853-8022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 MANTUA PIKE",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080963963",
            "telephone_number": "856-853-8004",
            "fax_number": "856-853-8022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ORTHOPAEDIC OF SOUTH JERSEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "LIPSCHULTZ",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DR",
        "authorized_official_telephone_number": "856-853-8004",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "NJ",
            "license": "MA054868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS",
            "identifier": "2423391000",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124197942",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADMINISTRATORS",
            "identifier": "610073",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1271200",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7002746",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "2423391000",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE",
            "identifier": "2423391000",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.