PRIMARY CARE MEDICAL PRACTICE, LLC
NPI 1912113002
Specialist in Woodland Park, NJ
About Primary Care Medical Practice, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PRIMARY CARE MEDICAL PRACTICE, LLC (NPI 1912113002) is a healthcare organization registered as a specialist in Woodland Park, New Jersey and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through January 1, 2027 and lists Samuel Issam Mallouhi, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Primary Care Medical Practice, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Primary Care Medical Practice, LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Woodland Park, NJ 07424
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 31D1007826
Primary Care Medical Practice LLC · West Paterson, 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 Primary Care Medical Practice, LLC's NPI number?
The NPI number for Primary Care Medical Practice, LLC is 1912113002. It was assigned to this organization in the NPPES registry on May 15, 2007.
Where is Primary Care Medical Practice, LLC located?
Primary Care Medical Practice, LLC is located at 1031 Mcbride Ave Suite D 205, Woodland Park, NJ 07424. The listed phone number is (973) 237-9055.
What is Primary Care Medical Practice, LLC's specialty?
The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.
Is Primary Care Medical Practice, LLC enrolled in Medicare?
Yes. Primary Care Medical Practice, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Primary Care Medical Practice, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (General Practice) reassigns their Medicare billing to Primary Care Medical Practice, 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 Primary Care Medical Practice, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 31D1007826) is associated with this NPI, valid through January 1, 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 Primary Care Medical Practice, LLC was last updated on July 1, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.
# Primary Care Medical Practice, Llc · NPI 1912113002
Specialist organization in Woodland Park, New Jersey. Organization record, active in the CMS NPPES registry since May 15, 2007.
## Identity
- **NPI:** 1912113002 (Entity type: Organization)
- **Enumerated:** May 15, 2007
- **Primary specialty:** Specialist · taxonomy 174400000X
- **Organization subpart:** No
- **Authorized official:** Samuel Mallouhi, PRESIDENT
## Practice location
- **Address:** 1031 MCBRIDE AVE, SUITE D 205, Woodland Park, NJ 07424-2559
- **Phone:** (973) 237-9055 · **Fax:** (973) 237-9053
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (General Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 1, 2013
- **Other identifiers:** Medicare UPIN 065655
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1912113002) · Data from the CMS NPPES public registry.