NPIMap

Individual provider Active NPI

Tomi T Prvulovic, MD

  • Pain Medicine (Anesthesiology) Physician
  • Cedar Knolls, NJ
National Provider Identifier
1831262559
Registry record updated Dec 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
25MA06129800 Issued in NJ
Practice address
197 Ridgedale Ave
Suite 101-C
Cedar Knolls, NJ 07927-2111
Phone
(973) 865-5111
Fax
(973) 292-0772
NPI assigned
Nov 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2011

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X 25MA06129800 NJ Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X 206029 NY
Interventional Pain Medicine Physician 208VP0014X 26MA06129800 NJ
Interventional Pain Medicine Physician 208VP0014X 206029 NY

Addresses

Primary practice location

197 Ridgedale Ave
Suite 101-C
Cedar Knolls, NJ 07927-2111

Mailing address

PO Box 4
Cedar Knolls, NJ 07927-0004
Phone (973) 865-5111

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
26MA06129800NJMDInterventional Pain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Warwick Anesthesia PC Pain Medicine PastSince Apr 30, 2003 Accepting new patients
Montclair Anesthesia Associates, P.C. Pain Medicine Past Accepting new patients
Warwick Anesthesia Group LLC Past Accepting new patients
Summit Anesthesia Associates PA Past Accepting new patients
Royal Oral & Maxillofacial Surgery PastSince Jun 1, 2020 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: tomi.prvulovic.1@21449.direct.athenahealth.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324425600000",
    "number": "1831262559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4",
            "city": "CEDAR KNOLLS",
            "state": "NJ",
            "postal_code": "079270004",
            "telephone_number": "973-865-5111",
            "fax_number": "201-939-1701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "197 RIDGEDALE AVE",
            "address_2": "SUITE 101-C",
            "city": "CEDAR KNOLLS",
            "state": "NJ",
            "postal_code": "079272111",
            "telephone_number": "973-865-5111",
            "fax_number": "973-292-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRVULOVIC",
        "first_name": "TOMI",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2011-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NJ",
            "license": "25MA06129800",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NY",
            "license": "206029",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NJ",
            "license": "26MA06129800",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NY",
            "license": "206029",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Knolls, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.