Active NPI
Joan McCormack, AU.D, CCC/A
- Audiologist
- Swampscott, MA
National Provider Identifier
1104853563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 237
- Practice address
- 990 Paradise Rd
Suite 1G
Swampscott, MA 01907-1395 - Phone
- (781) 479-6316
- Fax
- (781) 987-7272
- NPI assigned
- Jun 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 237 | MA | Primary |
Addresses
Primary practice location
990 Paradise Rd
Suite 1G
Swampscott, MA 01907-1395
Mailing address
49 Sherwood Rd
Swampscott, MA 01907-2147
Phone (781) 479-6316
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5102758 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 237 | MA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104853563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "49 SHERWOOD RD",
"city": "SWAMPSCOTT",
"state": "MA",
"postal_code": "019072147",
"telephone_number": "781-479-6316",
"fax_number": "781-987-7272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "990 PARADISE RD",
"address_2": "SUITE 1G",
"city": "SWAMPSCOTT",
"state": "MA",
"postal_code": "019071395",
"telephone_number": "781-479-6316",
"fax_number": "781-987-7272"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCORMACK",
"first_name": "JOAN",
"name_prefix": "Dr.",
"credential": "AU.D, CCC/A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "MA",
"license": "237",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5102758",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Swampscott, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.