| Ccg Medical Group LLC | |
|
673 Morris Ave Ste 201 Springfield NJ 07081-1512 | |
| (973) 759-9000 | |
| Not Available |
| Full Name | Ccg Medical Group LLC |
|---|---|
| Speciality | Specialist |
| Location | 673 Morris Ave Ste 201, Springfield, New Jersey |
| Authorized Official Name and Position | Clifford Sales (MANAGING BUSINESS PARTNER) |
| Authorized Official Contact | 9737599000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ccg Medical Group LLC 673 Morris Ave Ste 201 Springfield NJ 07081-1512 Ph: (973) 759-9000 | Ccg Medical Group LLC 673 Morris Ave Ste 201 Springfield NJ 07081-1512 Ph: (973) 759-9000 |
| NPI Number | 1245954254 |
|---|---|
| Provider Enumeration Date | 10/03/2022 |
| Last Update Date | 07/07/2025 |
| Certification Date | 07/07/2025 |
| Medicare PECOS PAC ID | 0648640680 |
|---|---|
| Medicare Enrollment ID | O20230106002797 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245954254 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (NU) | Secondary |
| 174400000X | Specialist | (NU) | Primary |
| Provider Name | Tricia a Johnson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1003819384 PECOS PAC ID: 0840275822 Enrollment ID: I20040623000453 |
| Provider Name | Clifford M Sales |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1053314005 PECOS PAC ID: 3173508157 Enrollment ID: I20040623000505 |
| Provider Name | Darlene Dobkowski |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1891753851 PECOS PAC ID: 8325013071 Enrollment ID: I20040827000076 |
| Provider Name | Raymond J Holmes |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1699771220 PECOS PAC ID: 4880667278 Enrollment ID: I20041103000484 |
| Provider Name | Elizabeth Coll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841293024 PECOS PAC ID: 1557328523 Enrollment ID: I20041213000190 |
| Provider Name | Roger Leonard Stein |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1932244910 PECOS PAC ID: 6204882715 Enrollment ID: I20050329000045 |
| Provider Name | Bruce Brener |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1053317636 PECOS PAC ID: 1052348596 Enrollment ID: I20050726000861 |
| Provider Name | Michael D Addis |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1275525743 PECOS PAC ID: 3577599562 Enrollment ID: I20050815000544 |
| Provider Name | Michael a Pontoriero |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1275536765 PECOS PAC ID: 0244260701 Enrollment ID: I20050816000100 |
| Provider Name | Jonathan a Levison |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1912900416 PECOS PAC ID: 5698705895 Enrollment ID: I20050817000705 |
| Provider Name | Kimberly Sweet |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1922008184 PECOS PAC ID: 6709815798 Enrollment ID: I20050830000024 |
| Provider Name | Michael Ombrellino |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1114997426 PECOS PAC ID: 6800811357 Enrollment ID: I20051013000347 |
| Provider Name | Deirdre Mcgagh |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1407957889 PECOS PAC ID: 7618949322 Enrollment ID: I20060407000575 |
| Provider Name | Salvador A. Cuadra |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1851310015 PECOS PAC ID: 8628088721 Enrollment ID: I20070203000039 |
| Provider Name | Cindy Sturt |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1073838173 PECOS PAC ID: 0042342719 Enrollment ID: I20100715000284 |
| Provider Name | Combiz Rezayat |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1891954947 PECOS PAC ID: 7618092792 Enrollment ID: I20100913000803 |
| Provider Name | Emily E Simmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003123720 PECOS PAC ID: 6507043452 Enrollment ID: I20110602000295 |
| Provider Name | Scott a Sundick |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1649449687 PECOS PAC ID: 1759547052 Enrollment ID: I20120731000320 |
| Provider Name | Cindy Bowman |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1245460187 PECOS PAC ID: 5698921302 Enrollment ID: I20120813000571 |
| Provider Name | Andrew Cha |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1568780500 PECOS PAC ID: 5092026856 Enrollment ID: I20150619001004 |
| Provider Name | Daniel I Fremed |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1548536436 PECOS PAC ID: 7416227673 Enrollment ID: I20170720000681 |
| Provider Name | Bijal Parmar |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1982123469 PECOS PAC ID: 0042586885 Enrollment ID: I20171024001259 |
| Provider Name | Kunal Vani |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1053729988 PECOS PAC ID: 4082017132 Enrollment ID: I20210727001312 |
| Provider Name | Neil H Poulsen |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1841610821 PECOS PAC ID: 4981930815 Enrollment ID: I20210727001623 |
| Provider Name | Elena Macias |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1376116152 PECOS PAC ID: 7315330594 Enrollment ID: I20220210002742 |
| Provider Name | Stephanie Seara |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1942841440 PECOS PAC ID: 8123488699 Enrollment ID: I20230714003128 |
| Provider Name | Jonathan Lee |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1538664933 PECOS PAC ID: 0244576197 Enrollment ID: I20230914003826 |
| Provider Name | Renae Elizabeth Sharkey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750163275 PECOS PAC ID: 4880030725 Enrollment ID: I20240313002981 |
| Provider Name | John Anagnostakos |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1255794269 PECOS PAC ID: 6800164153 Enrollment ID: I20250722003063 |
| Provider Name | Kristen Lee |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1295362754 PECOS PAC ID: 2567978943 Enrollment ID: I20250722003700 |
| Provider Name | Victoria Lora |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1104695006 PECOS PAC ID: 5395247399 Enrollment ID: I20250909000027 |
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