Emily Bacon, APN-C
Individual provider Active NPI Adult Health Nurse Practitioner · Woodbury, NJ
NPI 1962869016 · NPPES record last updated Dec 13, 2023
Key facts
- NPI
- 1962869016
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- 26NJ00612800 (NJ)
- Practice address
- 58 Euclid St
Woodbury, NJ 08096-4626 - Phone
- (856) 628-4504
- NPI assigned
- Jan 20, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Middlesex Psychiatry and TMS PC
Practice addresses (Care Compare)
777 Route 70 E
Suite G101
Marlton, NJ 08053-2548
Phone (856) 818-4020
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160615001754 | NJ | Practitioner - Nurse Practitioner | 5698066033 |
Reassigns benefits to 2 organizations Practice locations: Bridgeton, NJ |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NJ00612800 | NJ | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vista Medical Services, Inc. | Current |
Accepting new patients | |
| Middlesex Psychiatry & TMS PC | Current |
Accepting new patients | |
| Garden State Psychiatric Services, LLC | Current | Accepting new patients |
Locations
165 Passaic Ave
Ste 200
Fairfield, NJ 07004
Phone (800) 413-8020
777 Route 70 E
Ste G101
Marlton, NJ 08053
Phone (856) 818-4020
190 N Evergreen Ave
Ste 202
Woodbury, NJ 08096
Phone (856) 628-4504
160 Rock Hill Rd
Bala Cynwyd, PA 19004
Phone (610) 667-6080
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 26NJ00612800 | NJ | Yes |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 26NJ00612800 | NJ |
Addresses
Primary practice location
58 Euclid St
Woodbury, NJ 08096-4626
Mailing address
310 Woodstown Rd
Salem, NJ 08079
Phone (856) 628-4504
Other providers in Woodbury, NJ
- Assoc. for Retarded Citizens, Inc. Gloucester County
- Assoc. for Retarded Citizens, Inc. Gloucester County
- Avenues to Independent Living
- Avenues to Independent Living
- Morgen-Ashlee Backus
- Jennie Baile
- Samantha Baney
- Bannett Eye Centers PA
- Bannett Eye Centers, PA
- Gregg Allen Bannett
All providers in Woodbury, NJ · Adult Health Nurse Practitioner in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.