NPIMap

Organization Active NPI

Mass General Brigham Medical Group, Inc.

  • Internal Medicine Physician
  • Salem, NH
National Provider Identifier
1083360200
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MASS GENERAL BRIGHAM MEDICAL GROUP, INC.
Practice address
30 Tuscan Boulevard
Salem, NH 03079
Phone
(857) 282-7014
NPI assigned
Feb 25, 2022
Last updated
Dec 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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

Authorized official

Name
Vincent T McDermott
Title
Sr VP Finance/Cfo
Phone
(617) 243-6381

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary
Cardiovascular Disease Physician 207RC0000X NU
Gastroenterology Physician 207RG0100X NU
Ophthalmology Physician 207W00000X NU
Physical Therapist 225100000X NU
Audiologist 231H00000X NU

Addresses

Primary practice location

30 Tuscan Boulevard
Salem, NH 03079

Mailing address

30 Tuscan Boulevard
Salem, NH 03079

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH, MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220907001020 NH Part B Supplier - Clinic/Group Practice 3971987108 Receives reassigned benefits from 95 practitioners
Practice locations: Salem, NH
O20230925000368 MA Part B Supplier - Clinic/Group Practice 3971987108 Receives reassigned benefits from 206 practitioners
Practice locations: Boston, MA; Burlington, MA; Jamaica Plain, MA; Newton, MA; Salem, MA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
30D2262157Mass General Brigham Medical Group30 Tuscan Blvd, Ste 200, Salem, NH 03079Certificate of waiverJun 9, 2028

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: amin.jyothi.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: azenstein.eleonora.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: beaumont.erin.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: boucher.marcy.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: bryson.lauren.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: dalrymple.christine.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: ebrahimi.ali.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: fritz.douglas.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: fulling.nadine.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: giordano.suzanne.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: greenhalgh.kristen.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: hassan.ghinwa.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: knight.esperanza.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: kung.adrienne.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: kveraga.rikante.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: limberakis.jaclyn.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: lin.benjamin.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: loosigian.sarah.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: lungulescu.ovidiu.mgbicare@direct.partners.masshiway.net
  • Direct secure messaging: okeefe.kathleen.mgbicare@direct.partners.masshiway.net

Practitioners & affiliated clinicians

Practitioners 311

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 311

NPI Registry JSON

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

{
    "created_epoch": "1645747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1083360200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 TUSCAN BOULEVARD",
            "city": "SALEM",
            "state": "NH",
            "postal_code": "03079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 TUSCAN BOULEVARD",
            "city": "SALEM",
            "state": "NH",
            "postal_code": "03079",
            "telephone_number": "857-282-7014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASS GENERAL BRIGHAM MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-25",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "MCDERMOTT",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "SR VP FINANCE/CFO",
        "authorized_official_telephone_number": "617-243-6381"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.