NPIMap

Organization Active NPI

Rutgers Health-PCC Monument Square

  • Family Medicine Physician
  • New Brunswick, NJ
National Provider Identifier
1912089731
Registry record updated Jul 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RUTGERS HEALTH-PCC MONUMENT SQUARE
Practice address
317 George St
First Floor
New Brunswick, NJ 08901-2008
Phone
(732) 235-8993
NPI assigned
Oct 20, 2006
Last updated
Jul 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2017

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

Authorized official

Name
Ms. Barbara Walter
Title
Provider Enrollment Manager
Phone
(732) 212-0051

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

317 George St
First Floor
New Brunswick, NJ 08901-2008

Mailing address

66 West Gilbert St
Red Bank, NJ 07701
Phone (732) 212-0051

Other identifiers 1

IdentifierTypeStateIssuer
6602801MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040922000258 NJ Part B Supplier - Clinic/Group Practice 1052389582 Receives reassigned benefits from 59 practitioners
Practice locations: Piscataway, NJ; Toms River, NJ; South River, NJ; Somerset, NJ; Old Bridge, NJ; New Brunswick, NJ; Monroe, NJ; Livingston, NJ…

National Provider Directory

National Provider Directory

Member of 1

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

Locations

45 County Road 520
Ste 104
Englishtown, NJ 07726
Phone (732) 972-0660

1 Robert Wood Johnson Pl
#123
New Brunswick, NJ 08901

1 Robert Wood Johnson Pl
Ste 123
New Brunswick, NJ 08901
Phone (732) 235-8264

317 George St
Fl 1
New Brunswick, NJ 08901
Phone (732) 235-7828

317 George St
Fl First
New Brunswick, NJ 08901
Phone (732) 235-8993

Practitioners & affiliated clinicians

Practitioners 84

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 84

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499731200000",
    "number": "1912089731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 WEST GILBERT ST",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "07701",
            "telephone_number": "732-212-0051",
            "fax_number": "732-212-0713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 GEORGE ST",
            "address_2": "FIRST FLOOR",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089012008",
            "telephone_number": "732-235-8993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUTGERS HEALTH-PCC MONUMENT SQUARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2017-07-11",
        "status": "A",
        "authorized_official_last_name": "WALTER",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "732-212-0051",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6602801",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Brunswick, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.