NPIMap

Organization Active NPI

Daniel E Viders MD PC

  • Dermatology Physician
  • Auburn, MA
National Provider Identifier
1033163126
Registry record updated May 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
75666 Issued in MA
Legal business name
DANIEL E VIDERS MD PC
Practice address
207 Southbridge St
Auburn, MA 01501-2548
Phone
(508) 832-7118
Fax
(508) 917-8706
NPI assigned
May 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Daniel Evan Viders, MDNPI 1558354407
Title
Owner
Phone
(508) 832-7118

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 75666 MA Primary

Addresses

Primary practice location

207 Southbridge St
Auburn, MA 01501-2548

Mailing address

207 Southbridge St
Auburn, MA 01501-2548
Phone (508) 832-7118

Other identifiers 4

IdentifierTypeStateIssuer
651104OtherMATUFTS
4294OtherMAHARVARD PILGRIM
M19161OtherMABC/BS OF MASS
99700102OtherMANETWORK HEALTH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060306000536 MA Part B Supplier - Clinic/Group Practice 9931154283 Receives reassigned benefits from 5 practitioners
Practice locations: Auburn, MA

National Provider Directory

National Provider Directory

Locations

207 Southbridge St
Auburn, MA 01501
Phone (508) 832-7118

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620172800000",
    "number": "1033163126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 SOUTHBRIDGE ST",
            "city": "AUBURN",
            "state": "MA",
            "postal_code": "015012548",
            "telephone_number": "508-832-7118",
            "fax_number": "508-832-7166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 SOUTHBRIDGE ST",
            "city": "AUBURN",
            "state": "MA",
            "postal_code": "015012548",
            "telephone_number": "508-832-7118",
            "fax_number": "508-917-8706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANIEL E VIDERS MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A",
        "authorized_official_last_name": "VIDERS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "EVAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-832-7118",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MA",
            "license": "75666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "651104",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "4294",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF MASS",
            "identifier": "M19161",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NETWORK HEALTH",
            "identifier": "99700102",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Auburn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.