Rad Rheumatology & Autoimmune Disorders LLC

Primary specialty

Rheumatology PhysicianTaxonomy code 207RR0500X

License

211533 Issued in MA

Legal business name

RAD RHEUMATOLOGY & AUTOIMMUNE DISORDERS LLC

Doing business as

South Shore Rheumatology

Practice address

851 Main St
Suite 14
S Weymouth, MA 02190-1612

Phone

(508) 822-2874

Fax

(508) 880-0450

NPI assigned

Jan 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Aleksander Feoktistov, M.D.

Title

Owner

Phone

(508) 822-2874

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• South Shore Rheumatology Doing business as

Locations

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391644800000",
    "number": "1073660015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "851 MAIN ST",
            "address_2": "SUITE 14",
            "city": "S WEYMOUTH",
            "state": "MA",
            "postal_code": "021901612",
            "telephone_number": "508-822-2874",
            "fax_number": "508-880-0450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 MAIN ST",
            "address_2": "SUITE 14",
            "city": "S WEYMOUTH",
            "state": "MA",
            "postal_code": "021901612",
            "telephone_number": "508-822-2874",
            "fax_number": "508-880-0450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAD RHEUMATOLOGY & AUTOIMMUNE DISORDERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2014-02-06",
        "status": "A",
        "authorized_official_last_name": "FEOKTISTOV",
        "authorized_official_first_name": "ALEKSANDER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-822-2874",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "MA",
            "license": "211533",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9781510",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Shore Rheumatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Rheumatology Physician in S Weymouth, MA
• Providers in S Weymouth, MA by specialty
• Rheumatology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.