Individual provider Active NPI

Marcarious A Mariyampillai, MD

  • Internal Medicine Physician
  • Verona, NJ
National Provider Identifier
1790770279
Registry record updated Jun 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA06542600 Issued in NJ
Practice address
825 Bloomfield Ave
Suite LL-1
Verona, NJ 07044-1366
Phone
(973) 239-3770
Fax
(973) 239-3774
NPI assigned
Sep 12, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA06542600 NJ Primary

Addresses

Primary practice location

825 Bloomfield Ave
Suite LL-1
Verona, NJ 07044-1366

Mailing address

825 Bloomfield Ave
Suite LL-1
Verona, NJ 07044-1366
Phone (973) 239-3770

Other identifiers 1

IdentifierTypeStateIssuer
7326904MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050620000419 NJ Practitioner - Internal Medicine 8729022884 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Internal Medicine of Morris County LLCGroup PAC ID 2466428388, 77 clinicians

Practice addresses (Care Compare)

25 Pocono Rd
Denville, NJ 07834-2954
Phone (973) 927-5788

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Internal Medicine of Morris County LLC Internal Medicine CurrentSince Mar 1, 2023 Accepting new patients
Fall Prevention and Rehabilitation, LLP Past Accepting new patients
Vital Medical Forces of Dover PC Internal Medicine Past Accepting new patients
Prime Healthcare Services - Saint Clare'S LLC Past Accepting new patients

Locations

25 Pocono Rd
Denville, NJ 07834
Phone (273) 625-6000

400 W Blackwell St
Dover, NJ 07801
Phone (973) 537-3818

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214179200000",
    "number": "1790770279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 BLOOMFIELD AVE",
            "address_2": "SUITE LL-1",
            "city": "VERONA",
            "state": "NJ",
            "postal_code": "070441366",
            "telephone_number": "973-239-3770",
            "fax_number": "973-239-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 BLOOMFIELD AVE",
            "address_2": "SUITE LL-1",
            "city": "VERONA",
            "state": "NJ",
            "postal_code": "070441366",
            "telephone_number": "973-239-3770",
            "fax_number": "973-239-3774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARIYAMPILLAI",
        "first_name": "MARCARIOUS",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-12",
        "last_updated": "2008-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA06542600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7326904",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Verona, NJ

Sources for this page

Verify at the official NPI Registry.