NPIMap

Individual provider Active NPI

Victoria Catherine Vallejo, PA-C

  • Physician Assistant
  • Eatontown, NJ
National Provider Identifier
1851648687
Registry record updated Apr 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00464400 Issued in NJ
Practice address
11 Meridian Rd
Eatontown, NJ 07724-2242
Phone
(732) 663-0300
Fax
(732) 663-0301
NPI assigned
Aug 10, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 015871 NY
Physician Assistant 363A00000X 25MP00464400 NJ Primary

Addresses

Primary practice location

11 Meridian Rd
Eatontown, NJ 07724-2242

Mailing address

11 Meridian Rd
Eatontown, NJ 07724-2242
Phone (732) 663-0300

Other practice location 1

222 Schanck Rd Ste 104
Freehold, NJ 07728-2974
Phone (732) 431-1332

Other identifiers 2

IdentifierTypeStateIssuer
015871OtherNYSTATE LICENSE
25MP00464400OtherNJSTATE LICENSE

Other names 1

  • Victoria Catherin Glowacky Former name

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
I20180510000474 NJ Practitioner - Physician Assistant 3375772056 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Monmouth Cardiology Associates, LLCGroup PAC ID 6901881200, 43 clinicians

Practice addresses (Care Compare)

11 Meridian Rd
Eatontown, NJ 07724-2242
Phone (732) 663-0300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.83 of 100Reported as group
Quality
73.77
Promoting interoperability
95
Improvement activities
40
Cost
73.16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
015871NYMDClinical Psychologist

Interoperability endpoints

  • Direct secure messaging: vvallejo@mca.gwaydirect.com

Organizations & group practices 1

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 11

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": "1344556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524096000000",
    "number": "1851648687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 MERIDIAN RD",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077242242",
            "telephone_number": "732-663-0300",
            "fax_number": "732-663-0301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 MERIDIAN RD",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077242242",
            "telephone_number": "732-663-0300",
            "fax_number": "732-663-0301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "222 Schanck Rd Ste 104",
            "address_purpose": "LOCATION",
            "city": "Freehold",
            "state": "NJ",
            "postal_code": "077282974",
            "country_code": "US",
            "telephone_number": "732-431-1332",
            "fax_number": "732-431-1712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VALLEJO",
        "first_name": "VICTORIA",
        "middle_name": "CATHERINE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-10",
        "last_updated": "2018-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "015871",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00464400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "015871",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "25MP00464400",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICTORIA",
            "last_name": "GLOWACKY",
            "middle_name": "CATHERIN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Eatontown, NJ

Sources for this page

Verify at the official NPI Registry.