Allam Medical Group LLC
Organization Active NPI Internal Medicine Physician · Montclair, NJ
NPI 1972994077 · NPPES record last updated Feb 10, 2015
Key facts
- NPI
- 1972994077
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- ALLAM MEDICAL GROUP LLC
- Practice address
- 73 Park St
3Rd Floor
Montclair, NJ 07042-2903 - Phone
- (973) 746-0595
- NPI assigned
- Feb 10, 2015
- Organization subpart
- No
Authorized official
- Name
- Dr. Naveen Allam, M.D.
- Title
- Partner
- Phone
- (973) 746-0595
Practitioners 5
-
Naveen Reddy Allam, M.D.
-
Bharat Reddy Allam, D.O.
-
Reddy B Allam, MD
-
Ayesha I Malik, MD
-
Rajitha R. Gujja, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 31D0993479 | Allam Medical Group LLC | Certificate of waiver | Feb 16, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160113000812 | NJ | Part B Supplier - Clinic/Group Practice | 9537461140 |
Receives reassigned benefits from 4 practitioners Practice locations: Montclair, NJ |
National Provider Directory
Locations
73 Park St
Ste 3
Montclair, NJ 07042
Phone (973) 233-9258
Interoperability endpoints
- https://api.platform.athenahealth.com/16546/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
73 Park St
3Rd Floor
Montclair, NJ 07042-2903
Mailing address
73 Park St
3Rd Floor
Montclair, NJ 07042-2903
Other providers in Montclair, NJ
- Alfred S Nemlick, M.D., P.a.
- Aryan Mahmood Ali
- Rafia Wajahat Ali
- Augustine Yao Alifo
- All Total Health Care
- Bharat Reddy Allam
- Naveen Reddy Allam
- Reddy B Allam
- Allen Roth Educational and Psychological Services
- Allies, Inc.
All providers in Montclair, NJ · Internal Medicine Physician 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 Feb 10, 2015. 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.
- 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.