Carlos Sacristan, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

MA61947 Issued in NJ

Practice address

17-19 Howe Ave
Passaic, NJ 07055-4017

Phone

(973) 473-4399

Fax

(973) 473-3039

NPI assigned

Nov 30, 2005

Last updated

Dec 30, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

General Practice

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Visiting Health Services of New Jersey Home health agency, Woodland Park, NJ, CCN 317058
• St Mary's General Hospital Hospital, Passaic, NJ, CCN 310006
• St Joseph's University Medical Center Inc Hospital, Paterson, NJ, CCN 310019

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Carlos Sacristan, M.D., LLC

  • General Practice Physician
  • Passaic, NJ
  • NPI 1629363627
  Medicare reassignment NPD Authorized official

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

• Prime Healthcare Services - St. Mary's Passaic LLC

  dba St. Mary's Hospital

  • General Acute Care Hospital
  • Passaic, NJ
  • NPI 1770901761
  Care Compare affiliation
• St Josephs University Medical Center Inc.

  • General Acute Care Hospital
  • Paterson, NJ
  • NPI 1669462420
  Care Compare affiliation
• Vhsnj at Home, LLC

  dba Visiting Health Services of New Jersey

  • Home Health Agency
  • Woodland Park, NJ
  • NPI 1518407642
  Care Compare affiliation

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293667200000",
    "number": "1811971229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17-19 HOWE AVE",
            "address_2": "P.O. BOX 327",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070554017",
            "telephone_number": "973-473-4399",
            "fax_number": "973-473-4430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17-19 HOWE AVE",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070554017",
            "telephone_number": "973-473-4399",
            "fax_number": "973-473-3039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SACRISTAN",
        "first_name": "CARLOS",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2010-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NJ",
            "license": "MA61947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7255306",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blair Rush-Gove, LCSW
• Morgan Russo
• Adina Sabovich
• Sarina Sachdev, M.D.
• Joann M Sackett, LCSW
• Saint Mary's Passaic LLC
• Ronald Ray Sales, P.T.
• Ibrahim Salib
• Salvatore M. Gagliano M.D.P.a.
• San Juan Heart, LLC

• General Practice Physician in Passaic, NJ
• Providers in Passaic, NJ by specialty
• General Practice Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.