NPIMap

Organization Active NPI

Lahey Clinic, Inc

  • Internal Medicine Physician
  • Peabody, MA
National Provider Identifier
1063447316
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2778 Issued in MA
Legal business name
LAHEY CLINIC, INC
Practice address
1 Essex Center Dr
Peabody, MA 01960-2901
Phone
(781) 744-8000
NPI assigned
Jul 12, 2006
Last updated
Oct 17, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
BETH ISRAEL LAHEY HEALTH INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Authorized official

Name
Susan D Moffatt-Bruce, MDNPI 1225082167
Title
President
Phone
(781) 744-8594

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
Internal Medicine Physician 207R00000X 2778 MA Primary

Addresses

Primary practice location

1 Essex Center Dr
Peabody, MA 01960-2901

Mailing address

41 Mall Rd
Burlington, MA 01805-0001
Phone (781) 744-8085

Other identifiers 3

IdentifierTypeStateIssuer
9770585MedicaidMA
9729097MedicaidMA
CA5075OtherRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040629001269 MA Part B Supplier - Clinic/Group Practice 2264336528 Receives reassigned benefits from 2,070 practitioners
1 other NPI on this enrollment
Practice locations: Ipswich, MA; Worcester, MA; Lawrence, MA; Lynn, MA; Newburyport, MA; North Andover, MA; Peabody, MA; Peobody, MA…

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

152 Conant St
Beverly, MA 01915
Phone (978) 927-1919

298 Washington St
Fl 4
Gloucester, MA 01930
Phone (978) 283-2726

205 Willow St
Ste C
South Hamilton, MA 01982
Phone (978) 468-7346

Practitioners & affiliated clinicians

Practitioners 2,298

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 2,298

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1063447316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 MALL RD",
            "city": "BURLINGTON",
            "state": "MA",
            "postal_code": "018050001",
            "telephone_number": "781-744-8085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ESSEX CENTER DR",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019602901",
            "telephone_number": "781-744-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAHEY CLINIC, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BETH ISRAEL LAHEY HEALTH INC",
        "enumeration_date": "2006-07-12",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "MOFFATT-BRUCE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-744-8594",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "2778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9770585",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9729097",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA5075",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peabody, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.