CCMMA NJ LLC — NPI 1124543095 (Board-Certified Anesthesiologist & Interventional Pain Specialist in PASSAIC, NJ)

CMS-1500 Box 24J / 33a • NPI

1124543095

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

207LC0200X (CMS 05)

Board-Certified Anesthesiologist & Interventional Pain Specialist

Box 32 Service Location & ZIP+4

350 BOULEVARD, PASSAIC, NJ, 07055-2840

✓ 9-Digit EDI 837 ZIP+4 (07055-2840)

Practice Phone & Referral Fax

(973) 365-4300

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1124543095 (CCMMA NJ LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1124543095` (NPI-2 Organization / Facility)
Provider / Legal Name	CCMMA NJ LLC
Plain-English Specialty	Board-Certified Anesthesiologist & Interventional Pain Specialist NUCC Code: `207LC0200X` (Anesthesiology, Critical Care Medicine)
Certifying / Licensing Body	American Board of Anesthesiology (ABA)
Practice Location Address	350 BOULEVARD, PASSAIC, NJ, 07055-2840
Practice Telephone / Fax	Tel: (973) 365-4300
Administrative Mailing Address	PO BOX 631800, CINCINNATI, OH, 45263-1800
Enumeration & Last Sync	Enumerated: 2017-08-11 \| CMS Record Updated: 2022-10-14
Authorized Official	LAURIE LADUCA (MANAGER)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

350 BOULEVARD, PASSAIC, NJ, 07055-2840

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Plain-English Taxonomy & CMS Crosswalk (207LC0200X)

What Does Taxonomy Code 207LC0200X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207LC0200X translates to:
"Board-Certified Anesthesiologist & Interventional Pain Specialist"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 05 (Physician/Anesthesiology)
Certifying / Accrediting Authority: American Board of Anesthesiology (ABA)
Clinical Scope: Pre-surgical anesthesia evaluation, obstetric labor epidural care, or interventional spine and nerve block procedures for chronic pain.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (CCMMA NJ LLC)

Typical CPT / Diagnostic Procedures:

General Endotracheal Anesthesia & Total Intravenous Anesthesia (TIVA)
Ultrasound-Guided Peripheral Nerve Blocks & Labor Epidural Analgesia
Fluoroscopic Epidural Steroid Injections & Facet Joint Blocks

Common Therapeutic Classes:

Propofol, Sevoflurane, Rocuronium & Sugammadex
Bupivacaine, Lidocaine & Ropivacaine Regional Anesthetics

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`207RC0200X` — Internal Medicine, Critical Care Medicine Plain English: Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician)	State: N/A \| License: `Verified` \| Primary: Secondary
`207RP1001X` — Internal Medicine, Pulmonary Disease Plain English: Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician)	State: N/A \| License: `Verified` \| Primary: Secondary
`208600000X` — Surgery Plain English: Board-Certified Orthopedic Surgeon (Bone, Joint, Spine & Sports Injury Surgeon)	State: N/A \| License: `Verified` \| Primary: Secondary
`207LC0200X` — Anesthesiology, Critical Care Medicine Plain English: Board-Certified Anesthesiologist & Interventional Pain Specialist	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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CCMMA NJ LLC (NPI #1124543095)