Ramazi Otarovich Datiashvili

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

25MA06921300 Issued in NJ

Practice address

90 Bergen St
Doc 7200
Newark, NJ 07103-2425

Phone

(973) 972-1129

Fax

(973) 972-2407

NPI assigned

Dec 26, 2006

Last updated

Aug 21, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Plastic and Reconstructive Surgery

Education

Other, 1972

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University Physician Associates of New Jersey IncGroup PAC ID 9830003417, 374 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• The University Hospital Hospital, Newark, NJ, CCN 310119

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• University Physician Associates of New Jersey Inc

  dba University Surgical Associates

  • Surgery Physician
  • Newark, NJ
  • NPI 1639189236
  Medicare reassignment Care Compare group NPD
• University Physician Associates of New Jersey Inc

  dba University Medical Associates

  • Internal Medicine Physician
  • Newark, NJ
  • NPI 1760492367
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• University Hospital

  • General Acute Care Hospital
  • Newark, NJ
  • NPI 1215998323
  Care Compare affiliation

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250812800000",
    "number": "1952466518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 BERGEN ST",
            "address_2": "ADMC 12 1205",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071073000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 BERGEN ST",
            "address_2": "DOC 7200",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032425",
            "telephone_number": "973-972-1129",
            "fax_number": "973-972-2407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DATIASHVILI",
        "first_name": "RAMAZI",
        "middle_name": "OTAROVICH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-26",
        "last_updated": "2009-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "NJ",
            "license": "25MA06921300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8516006",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rajeshree Das, MD
• Sumon Kumar Das, M.D.
• Juliana N Dasilva
• Mohammad Hossein Dastjerdi, MD
• Daterra Psychotherapy and Wellness, Inc.
• Myrna L Datilus
• David Iosebashvili PC
• Anthony David, LMSW
• Artemio S David Jr., APN
• Rebecca Davidman, MS, OTR

• Plastic and Reconstructive Surgery Physician in Newark, NJ
• Providers in Newark, NJ by specialty
• Plastic and Reconstructive Surgery Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.