PINEBROOK MEDICAL CENTER LLC,
NPI 1811205024
Clinic/Center - Primary Care in Montville, NJ
About Pinebrook Medical Center Llc, NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PINEBROOK MEDICAL CENTER LLC, (NPI 1811205024) is a healthcare organization registered as a primary care in Montville, New Jersey and active in the NPI registry since September 2010. The organization holds a CLIA Waiver certificate valid through November 4, 2027 and lists Thomas Stack, Owner/doctor, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Pinebrook Medical Center Llc, is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by February 28, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Pinebrook Medical Center LLC,, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 31D0993076
Pinebrook Medical Center · Montville, NJFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Pinebrook Medical Center LLC,'s NPI number?
The NPI number for Pinebrook Medical Center LLC, is 1811205024. It was assigned to this organization in the NPPES registry on September 22, 2010.
Where is Pinebrook Medical Center LLC, located?
Pinebrook Medical Center LLC, is located at 170 Changebridge Road Suite A-3, Montville, NJ 07045. The listed phone number is (973) 808-3200.
What is Pinebrook Medical Center LLC,'s specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Pinebrook Medical Center LLC, enrolled in Medicare?
Yes. Pinebrook Medical Center LLC, is registered in the Medicare PECOS enrollment system.
When is Pinebrook Medical Center LLC,'s Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (New Jersey, Clinic/Group Practice) is due for revalidation by February 28, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Pinebrook Medical Center LLC,?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Pinebrook Medical Center LLC,. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Pinebrook Medical Center LLC, hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 31D0993076) is associated with this NPI, valid through November 4, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Pinebrook Medical Center LLC, was last updated on September 22, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Pinebrook Medical Center Llc, · NPI 1811205024
Primary Care organization in Montville, New Jersey. Organization record, active in the CMS NPPES registry since September 22, 2010.
## Identity
- **NPI:** 1811205024 (Entity type: Organization)
- **Enumerated:** September 22, 2010
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Thomas Stack, OWNER/DOCTOR
## Practice location
- **Address:** 170 CHANGEBRIDGE ROAD, SUITE A-3, Montville, NJ 07045
- **Phone:** (973) 808-3200 · **Fax:** (973) 808-3202
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** February 28, 2027 (Non-DME Part B, New Jersey, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 22, 2010
- **Other identifiers:** Medicare PIN ST624751 (NJ); Medicare UPIN F93378 (NJ)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1811205024) · Data from the CMS NPPES public registry.