Jason Andrew Fawley, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

280467 Issued in MA

Practice address

15 Parkman Street
Churchill Surgical Clinic
Bost, MA 02114-3117

Phone

(617) 643-7557

NPI assigned

Apr 25, 2011

Last updated

Oct 4, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA, CA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

General Surgery

Education

Loma Linda University School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Scripps HealthGroup PAC ID 9234033853, 1,450 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Scripps Memorial Hospital la Jolla Hospital, La Jolla, CA, CCN 050324
• UC San Diego Health Hillcrest - Hillcrest Med Ctr Hospital, San Diego, CA, CCN 050025
• Scripps Memorial Hospital - Encinitas Hospital, Encinitas, CA, CCN 050503

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Scripps Health

  dba Scripps Clinic

  • Multi-Specialty Clinic/Center
  • La Jolla, CA
  • NPI 1275899072
  Medicare reassignment Care Compare group NPD
• Massachusetts General Physicians Organization Inc

  • Dermatology Physician
  • Boston, MA
  • NPI 1801874573

  Surgery

  Medicare reassignment NPD
• The General Hospital Corporation

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1023049236
  Medicare reassignment NPD
• Scripps Health

  dba Scripps Home Health Care Services

  • Home Health Agency
  • San Diego, CA
  • NPI 1578556114
  NPD
• Scripps Health

  dba Scripps Memorial Hospital La Jolla

  • General Acute Care Hospital
  • La Jolla, CA
  • NPI 1841277704
  NPD
• Children's Hospital of Wisconsin, Inc.

  • Children's Hospital
  • Milwaukee, WI
  • NPI 1750482022
  NPD (past)
• Scripps Clinic Medical Group

  • Multi-Specialty Clinic/Center
  • San Diego, CA
  • NPI 1124003280
  NPD (past)
• Scripps Health

  • Clinical Medical Laboratory
  • La Jolla, CA
  • NPI 1427034990
  NPD (past)
• Scripps Health

  dba Scripps Green Hospital

  • General Acute Care Hospital
  • La Jolla, CA
  • NPI 1841233780
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Regents of the University of California

  dba UCSD Medical Center

  • General Acute Care Hospital
  • San Diego, CA
  • NPI 1184722779
  Care Compare affiliation
• Scripps Health

  dba Scripps Memorial Hospital Encinitas

  • General Acute Care Hospital
  • Encinitas, CA
  • NPI 1700829199
  Care Compare affiliation
• Scripps Health

  dba Scripps Memorial Hospital La Jolla

  • General Acute Care Hospital
  • La Jolla, CA
  • NPI 1841277704
  Care Compare affiliation

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

{
    "created_epoch": "1303689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570147200000",
    "number": "1114218146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 CAMBRIDGE ST STE 810",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 PARKMAN STREET",
            "address_2": "CHURCHILL SURGICAL CLINIC",
            "city": "BOST",
            "state": "MA",
            "postal_code": "021143117",
            "telephone_number": "617-643-7557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAWLEY",
        "first_name": "JASON",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-25",
        "last_updated": "2019-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "280467",
            "primary": true
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "MA",
            "license": "280467",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114218146",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.