Individual provider Active NPI

Karan Omidvari, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Hackensack, NJ
National Provider Identifier
1962474742
Registry record updated Jan 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
139772 Issued in NJ
Practice address
385 Prospect Ave Ste 204
Hackensack, NJ 07601-2570
Phone
(551) 996-9190
NPI assigned
Feb 6, 2006
Last updated
Jan 7, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2020

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 219979 NY
Pulmonary Disease Physician 207RP1001X 219979 NY
Hospitalist Physician 208M00000X 219979 NY
Hospitalist Physician 208M00000X MA56381 NJ
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 139772 NJ Primary

Addresses

Primary practice location

385 Prospect Ave Ste 204
Hackensack, NJ 07601-2570

Mailing address

170 E 87TH St Apt W11A
New York, NY 10128-2238
Phone (201) 967-8425

Other practice location 1

17 Elm Ave Fl 3
Hackensack, NJ 07601-4702
Phone (201) 967-8425

Other practice location 2

30 Prospect Ave
Critical Care Unit
Hackensack, NJ 07601-1915
Phone (551) 996-3500

Other identifiers 2

IdentifierTypeStateIssuer
80187MedicaidNJ
25MA05638100OtherNJSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20040304000985 NY Practitioner - Critical Care (Intensivists)Practitioner - Pulmonary Disease 5890683627 Reassigns benefits to 1 organization
I20051028000618 NJ Practitioner - Critical Care (Intensivists)Practitioner - Pulmonary Disease 5890683627 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Pulmonary Disease
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

30 Prospect Ave
Hackensack, NJ 07601-1915
Phone (551) 996-5045

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.78 of 100Reported as individual
Quality
94.47
Improvement activities
0
Cost
80.32

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
139772NJMDCritical Care Medicine (Internal Medicine) Physician
219979NYMDPulmonary Disease Physician
MA56381NJMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Jan 14, 2020 Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC Internal Medicine CurrentSince Jan 14, 2020 Accepting new patients
Cathedral Physician Services, P.C. Past Accepting new patients
Lsu Medical Center Past Accepting new patients
Park Lenox Medical, PC Internal Medicine Past Accepting new patients
Dac Physician Services,PC Internal Medicine PastSince May 3, 2004 Accepting new patients
Louisiana State University School of Medicine in New Orleans Faculty G Past Accepting new patients

Locations

385 Prospect Ave
Ste 204
Hackensack, NJ 07601
Phone (551) 996-9140

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

20 Prospect Ave
Ste 615
Hackensack, NJ 07601
Phone (201) 996-0308

111 Central Ave
Newark, NJ 07102
Phone (973) 877-5060

130 Kinderkamack Rd
Ste 203
River Edge, NJ 07661
Phone (201) 343-4910

Interoperability endpoints

  • Direct secure messaging: karan.omidvari@direct.hackensackmeridian.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD

Organizations & group practices 9

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.

Hospital & facility affiliations 2

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": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578355200000",
    "number": "1962474742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 E 87TH ST APT W11A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101282238",
            "telephone_number": "201-967-8425",
            "fax_number": "201-263-4665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "385 PROSPECT AVE STE 204",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076012570",
            "telephone_number": "551-996-9190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17 Elm Ave Fl 3",
            "address_purpose": "LOCATION",
            "city": "Hackensack",
            "state": "NJ",
            "postal_code": "076014702",
            "country_code": "US",
            "telephone_number": "201-967-8425",
            "fax_number": "201-263-4665",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "30 Prospect Ave",
            "address_2": "Critical Care Unit",
            "address_purpose": "LOCATION",
            "city": "Hackensack",
            "state": "NJ",
            "postal_code": "076011915",
            "country_code": "US",
            "telephone_number": "551-996-3500",
            "fax_number": "551-996-3298",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OMIDVARI",
        "first_name": "KARAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-06",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "219979",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NY",
            "license": "219979",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "219979",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NJ",
            "license": "MA56381",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NJ",
            "license": "139772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80187",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "25MA05638100",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

Verify at the official NPI Registry.