NPIMap

Individual provider Active NPI

Jaya Reddy Kothapally, M.D

  • Endocrinology, Diabetes & Metabolism Physician
  • Willingboro, NJ
National Provider Identifier
1790894954
Registry record updated Jun 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
25MA08944000 Issued in NJ
Practice address
218 C. Sunset Road
Willingboro, NJ 08046
Phone
(609) 877-0400
Fax
(609) 877-3542
NPI assigned
Aug 30, 2006
Last updated
Jun 11, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 2006012190 MO
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 25MA08944000 NJ Primary

Addresses

Primary practice location

218 C. Sunset Road
Willingboro, NJ 08046

Mailing address

218 C. Sunset Road
Willingboro, NJ 08046
Phone (609) 877-0400

Other identifiers 1

IdentifierTypeStateIssuer
25MA08944000OtherNJMEDICAL LICENSE

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
I20120329000572 NJ Practitioner - EndocrinologyPractitioner - Internal Medicine 9739349663 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

218 C Sunset Rd
Willingboro, NJ 08046-1104
Phone (609) 877-0400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.83 of 100Reported as group
Quality
88.78
Promoting interoperability
99
Improvement activities
40
Cost
74.17

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA08944000NJMDEndocrinology, Diabetes & Metabolism Physician
2006012190MOMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
CMC Department of Medicine Endocrinology, Diabetes & Metabolism CurrentSince Feb 14, 2012 Accepting new patients
CMC Department of Medicine Group PA CurrentSince Feb 14, 2012 Accepting new patients

Locations

1 Federal St
Ste SW200
Camden, NJ 08103
Phone (856) 356-4920

3 Cooper Plz
Rm 215
Camden, NJ 08103
Phone (856) 342-2439

309 Bridgeboro Rd
Moorestown, NJ 08057
Phone (856) 439-2000

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

218C Sunset Rd
Willingboro, NJ 08046
Phone (609) 877-0400

Interoperability endpoints

  • Direct secure messaging: jkothapally29861@direct.cooperhealth.edu

Organizations & group practices 3

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 4

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402444800000",
    "number": "1790894954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 C. SUNSET ROAD",
            "city": "WILLINGBORO",
            "state": "NJ",
            "postal_code": "08046",
            "telephone_number": "609-877-0400",
            "fax_number": "609-877-3542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 C. SUNSET ROAD",
            "city": "WILLINGBORO",
            "state": "NJ",
            "postal_code": "08046",
            "telephone_number": "609-877-0400",
            "fax_number": "609-877-3542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTHAPALLY",
        "first_name": "JAYA",
        "middle_name": "REDDY",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2014-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MO",
            "license": "2006012190",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NJ",
            "license": "25MA08944000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "25MA08944000",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Willingboro, NJ

Sources for this page

Verify at the official NPI Registry.