NPIMap

Organization Active NPI

Rutgers RWJ Eric B. Chandler Health Center

  • Federally Qualified Health Center (FQHC)
  • New Brunswick, NJ
National Provider Identifier
1851330815
Registry record updated Jul 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
22211 Issued in NJ
Legal business name
RUTGERS RWJ ERIC B. CHANDLER HEALTH CENTER
Practice address
277 George St
New Brunswick, NJ 08901-1311
Phone
(732) 235-7406
Fax
(732) 235-6726
NPI assigned
Jun 5, 2006
Organization subpart
Yes
Parent organization
RUTGERS THE STATE UNIVERSITY OF NEW JERSEYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 2, 2013

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

Authorized official

Name
Sandra Adams
Title
Interim Executive Director
Phone
(732) 235-6756

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 22211 NJ Primary

Addresses

Primary practice location

277 George St
New Brunswick, NJ 08901-1311

Mailing address

277 George St
New Brunswick, NJ 08901-1311
Phone (732) 235-7406

Other identifiers 1

IdentifierTypeStateIssuer
0043401MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040116000249 NJ Part B Supplier - Clinic/Group Practice 0042111601 Receives reassigned benefits from 38 practitioners
2 other NPIs on this enrollment
Practice locations: New Brunswick, NJ
O20080219000440 NJ Part A Provider - Federally Qualified Health Center (FQHC) 0042111601 Practice locations: New Brunswick, NJ

Federally qualified health center certification: CCN 311811

Legal name
RUTGERS RWJ ERIC B. CHANDLER HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 22, 1992
Last certification
Oct 22, 1992
Ownership / control type
Non-profit – other
Organization structure
OtherNon-profit
Incorporated
Oct 22, 1992 in NJ
Enrollment address
277 George St
New Brunswick, NJ 89011311
Related CCNs
310038

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Eric B Chandler HLTH CN3 organizations share this tax ID, including this one
Part of
Rutgers the State Univ

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

277 George St
New Brunswick, NJ 08901
Phone (732) 235-6700

123 Church St
New Brunswick, NJ 08901
Phone (732) 235-2052

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Sean Hewitt Individual Operational/Managerial ControlCommunity Board Vice Chairperson Jul 1, 2013
Rutgers the State University of New Jersey Organization, Piscataway, NJ 5% Or Greater Direct Ownership Interest Jul 1, 2013
Joseph Perez Individual Operational/Managerial ControlCommunity Board Treasurer Jul 1, 2013
Edith Brown Individual Operational/Managerial ControlCommunity Board Member Jul 1, 2013
Rodney Reid Individual W-2 Managing Employee Mar 8, 2006
Sandra T Hill Individual Corporate Director Dec 1, 2007
W-2 Managing EmployeeExecutive Director Nov 4, 2016 100%
Rose Flowers Individual Operational/Managerial ControlCommunity Board Member Jul 1, 2013
Susan Jackson Individual Operational/Managerial ControlCommunity Board Secretary Jul 1, 2013
Lauren Moore-Carrington Individual Operational/Managerial ControlCommunity Board Chairperson Jul 1, 2013

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 55

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

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372723200000",
    "number": "1851330815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 GEORGE ST",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089011311",
            "telephone_number": "732-235-7406",
            "fax_number": "732-235-6726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 GEORGE ST",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089011311",
            "telephone_number": "732-235-7406",
            "fax_number": "732-235-6726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUTGERS RWJ ERIC B. CHANDLER HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RUTGERS THE STATE UNIVERSITY OF NEW JERSEY",
        "enumeration_date": "2006-06-05",
        "last_updated": "2013-07-02",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "INTERIM EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "732-235-6756"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NJ",
            "license": "22211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0043401",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Brunswick, NJ

Sources for this page

Verify at the official NPI Registry.