NPIMap

Organization Active NPI

Central Jersey Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
National Provider Identifier
1982087607
Registry record updated Jan 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
22864 Issued in NJ
Legal business name
CENTRAL JERSEY MEDICAL CENTER, INC.
Practice address
359 13TH Ave
Newark, NJ 07103-2125
Phone
(973) 679-7709
Fax
(732) 324-5765
NPI assigned
Jun 30, 2015
Last updated
Jan 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2023

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

Authorized official

Name
Mr. Jack O'Leary
Title
Ceo
Phone
(732) 376-9333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 22864 NJ Primary

Addresses

Primary practice location

359 13TH Ave
Newark, NJ 07103-2125

Mailing address

PO Box 1220
Attn: Credentialing/HR
Perth Amboy, NJ 08862
Phone (732) 376-6635

Other names 2

  • Central Jersey Medical Center at 13th Ave School Other name
  • Jewish Renaissance Medical Center at 13th Ave School Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150819008410 NJ Part A Provider - Federally Qualified Health Center (FQHC) 1456301241 Practice locations: Newark, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982087607. Details of each certification follow.

Federally qualified health center certification: CCN 311921

Legal name
CENTRAL JERSEY MEDICAL CENTER INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 19, 2015
Last certification
Aug 19, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 1, 2001 in NJ
Enrollment address
359 13TH Ave
Newark, NJ 71032125

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Central Jersey Medical Center Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

359 13th Ave
Newark, NJ 07103
Phone (973) 679-7709

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
John T O'Leary Individual Corporate OfficerCeo May 17, 2018
Marta Ferreira Individual 5% Or Greater Direct Ownership Interest Sep 13, 2010
5% Or Greater Indirect Ownership Interest Sep 13, 2010
Corporate DirectorDirector of Human Resources Sep 13, 2010
W-2 Managing EmployeeDirector of Human Resources Sep 13, 2010
Thomas Boggiano Individual Corporate OfficerFinance Director Feb 1, 2017
Corporate DirectorFinance Director Feb 1, 2017

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674777600000",
    "number": "1982087607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1220",
            "address_2": "ATTN: CREDENTIALING/HR",
            "city": "PERTH AMBOY",
            "state": "NJ",
            "postal_code": "08862",
            "telephone_number": "732-376-6635",
            "fax_number": "732-324-5765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "359 13TH AVE",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032125",
            "telephone_number": "973-679-7709",
            "fax_number": "732-324-5765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL JERSEY MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-30",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A",
        "authorized_official_last_name": "O'LEARY",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "732-376-9333",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NJ",
            "license": "22864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Jersey Medical Center at 13th Ave School",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Jewish Renaissance Medical Center at 13th Ave School",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Newark, NJ

Sources for this page

Verify at the official NPI Registry.