Individual provider Active NPI

Luai Khalil Tabaza, MD

  • Interventional Cardiology Physician
  • Cherry Hill, NJ
National Provider Identifier
1922366244
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
25MA10699900 Issued in NJ
Practice address
1 Brace Rd Ste C1
Cherry Hill, NJ 08034-2600
Phone
(856) 428-4100
NPI assigned
Apr 24, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 9329 IA
Interventional Cardiology Physician 207RI0011X 25MA10699900 NJ Primary

Addresses

Primary practice location

1 Brace Rd Ste C1
Cherry Hill, NJ 08034-2600

Mailing address

301 Lippincott Dr Ste 410
Marlton, NJ 08053-4197
Phone (856) 355-0340

Other practice location 1

728 Marne Hwy Ste 200E
Moorestown, NJ 08057-3128
Phone (856) 291-8855

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address ltabaza138827@directvirtua.org
Direct Messaging Address ltabaza138827@directvirtua.org
Direct Messaging Address ltabaza138827@directvirtua.org

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200723002359 NJ Practitioner - Cardiovascular Disease (Cardiology) 6103118575 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians

Practice addresses (Care Compare)

1 Brace Rd
Cherry Hill, NJ 08034-2600

1 Sheffield Dr
Suite 201
Columbus, NJ 08022-9506
Phone (609) 291-8855

1105 Laurel Oak Rd
Voorhees, NJ 08043-4312

1600 Haddon Ave
Camden, NJ 08103-3101

175 Madison Ave
Mount Holly, NJ 08060-2038

2 Sindoni LN
Hammonton, NJ 08037-1884

212 Creek Crossing Blvd
Hainesport, NJ 08036-2766
Phone (609) 267-1004

239 Hurffville Crosskeys Rd
Suite 245
Sewell, NJ 08080-4006
Phone (856) 341-8300

3242 Route 206
Bordentown, NJ 08505-4517

728 Marne Hwy
Moorestown, NJ 08057-3128

730 N Broad St
Suite 200a
Woodbury, NJ 08096-1796
Phone (856) 251-2340

811 Sunset Rd
Burlington, NJ 08016-3645
Phone (609) 877-4545

90 Brick Rd
Marlton, NJ 08053-2177
Phone (856) 247-7260

Hospital & facility affiliations

  • Virtua Our Lady of Lourdes Hospital Hospital, Camden, NJ, CCN 310029
  • Virtua Mount Holly Hospital Hospital, Mount Holly, NJ, CCN 310057
  • West Jersey Hospital Hospital, Voorhees, NJ, CCN 310022

Merit-based Incentive Payment System (MIPS)

Final score
81.15 of 100Reported as group
Quality
62.28
Promoting interoperability
100
Improvement activities
40
Cost
74.89

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting57
Varicose vein removal31
Leg revascularization (restoring blood flow)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9329IAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA Internal Medicine CurrentSince Aug 20, 2020 Accepting new patients
Virtua Medical Group, PA CurrentSince Aug 20, 2020 Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

1 Brace Rd
Ste C1
Cherry Hill, NJ 08034
Phone (856) 428-4100

301 Lippincott Dr
Ste 410
Marlton, NJ 08053

728 Marne Hwy
Ste 200E
Moorestown, NJ 08057
Phone (856) 291-8855

728 Marne Hwy
Ste 100B
Moorestown, NJ 08057
Phone (856) 206-4765

728 Marne Hwy
Ste 100C2
Moorestown, NJ 08057
Phone (856) 309-5869

1105 Laurel Oak Rd
Ste 166
Voorhees, NJ 08043
Phone (856) 309-5869

Interoperability endpoints

  • Direct secure messaging: ltabaza138827@directvirtua.org

Organizations & group practices 2

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 3

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": "1335225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1922366244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LIPPINCOTT DR STE 410",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534197",
            "telephone_number": "856-355-0340",
            "fax_number": "856-355-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BRACE RD STE C1",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080342600",
            "telephone_number": "856-428-4100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "728 Marne Hwy Ste 200E",
            "address_purpose": "LOCATION",
            "city": "Moorestown",
            "state": "NJ",
            "postal_code": "080573128",
            "country_code": "US",
            "telephone_number": "856-291-8855",
            "fax_number": "856-291-8844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TABAZA",
        "first_name": "LUAI",
        "middle_name": "KHALIL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-24",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "9329",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NJ",
            "license": "25MA10699900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ltabaza138827@directvirtua.org",
            "affiliation": "N",
            "address_1": "728 Marne Hwy Ste 100C-2",
            "city": "Moorestown",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080573128",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ltabaza138827@directvirtua.org",
            "affiliation": "N",
            "address_1": "1105 Laurel Oak Rd Ste 166",
            "city": "Voorhees",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080434312",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ltabaza138827@directvirtua.org",
            "affiliation": "N",
            "address_1": "728 Marne Hwy Ste 200E",
            "city": "Moorestown",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080573128",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cherry Hill, NJ

Sources for this page

Verify at the official NPI Registry.