Dr Mavis Camalita Ermakov, RD, RN, CDE, APN is a medicare enrolled "Nurse Practitioner - Family" provider in Newark, New Jersey. Her current practice location is
741 Broadway, Newark, New Jersey. You can reach out to her office (for appointments etc.) via phone at
(973) 483-1300.
Dr Mavis Camalita Ermakov is licensed to practice in New Jersey (license number 26NJ00421400) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1265614911.
Healthcare Provider's Profile
| Full Name | Dr Mavis Camalita Ermakov |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Family |
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| Location | 741 Broadway, Newark, New Jersey |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1265614911
- Provider Enumeration Date: 12/04/2007
- Last Update Date: 08/17/2021
Medicare PECOS Information:
- PECOS PAC ID: 0143533620
- Enrollment ID: I20150714000714
Medical Identifiers
Medical identifiers for Dr Mavis Camalita Ermakov such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1265614911 | NPI | - | NPPES |
| 0143533620 | Medicaid | NJ | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 133V00000X | Dietitian, Registered | 0071705 (Illinois) | Secondary |
| 133VN1006X | Dietitian, Registered - Nutrition, Metabolic | 717052 (ID#) (Illinois) | Secondary |
| 163WD0400X | Registered Nurse - Diabetes Educator | 26NR112011600 (New Jersey) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 26NJ00421400 (New Jersey) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Mavis Camalita Ermakov allows following entities to bill medicare on her behalf.
| Provider Name | Newark Community Health Centers Inc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1740345693
PECOS PAC ID: 2163334665
Enrollment ID: O20090729000539 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Mavis Camalita Ermakov is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Mavis Camalita Ermakov, RD, RN, CDE, APN
731 Liberty Ct,
Piscataway, NJ 08854-7206
Ph: (732) 937-5952 | Dr Mavis Camalita Ermakov, RD, RN, CDE, APN
741 Broadway,
Newark, NJ 07104-4309
Ph: (973) 483-1300 |
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