NPIMap

Individual provider Active NPI

Nicholas M Tsanotelis, MD

  • Internal Medicine Physician
  • Whitman, MA
National Provider Identifier
1114900057
Registry record updated Sep 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
52667 Issued in MA
Practice address
312 Bedford Street
Whitman, MA 02382-0000
Phone
(781) 792-6000
Fax
(781) 792-6165
NPI assigned
Nov 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 52667 MA Primary

Addresses

Primary practice location

312 Bedford Street
Whitman, MA 02382-0000

Mailing address

312 Bedford St
Whitman, MA 02382-1859
Phone (781) 792-6000

Other identifiers 1

IdentifierTypeStateIssuer
3001784MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071129000106 MA Practitioner - Internal Medicine 2365531316 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Massachusetts Medical School, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Revere Medical of Massachusetts PCGroup PAC ID 0749715795, 113 clinicians
BMC Affiliated Physicians, Inc.Group PAC ID 9830133123, 543 clinicians
Steward Medical Group IncGroup PAC ID 2860688728, 23 clinicians

Practice addresses (Care Compare)

1 Pearl St
Suite 2400
Brockton, MA 02301-2865
Phone (508) 897-6050

235 N Pearl St
Brockton, MA 02301-1794
Phone (508) 427-3000

312 Bedford St
Whitman, MA 02382-1859
Phone (781) 792-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
52667MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
BMC Affiliated Physicians, Inc. Internal Medicine CurrentSince Jan 1, 2026 Accepting new patients
Steward Medical Group, Inc CurrentSince Dec 1, 2011 Accepting new patients
Steward Medical Group, Inc CurrentSince Dec 1, 2011 Accepting new patients
Revere Medical of Massachusetts, PC Internal Medicine CurrentSince Nov 19, 2024 Accepting new patients

Locations

77 Warren St
Brighton, MA 02135
Phone (617) 254-1271

77 Warren St
Fl 5
Brighton, MA 02135
Phone (617) 254-3376

11 Nevins St
Ste 201
Brighton, MA 02135
Phone (617) 789-2442

1 Pearl St
Brockton, MA 02301
Phone (508) 586-3600

1 Pearl St
Ste 2400
Brockton, MA 02301
Phone (508) 897-6050

235 N Pearl St
Brockton, MA 02301
Phone (508) 427-2525

1 Pearl St
Ste 1000
Brockton, MA 02301
Phone (508) 897-6050

15 Payson Rd
Ste 3
Foxboro, MA 02035
Phone (508) 772-1438

100 Amesbury St
Ste 103
Lawrence, MA 01840
Phone (978) 683-0157

312 Bedford St
Whitman, MA 02382
Phone (781) 447-8700

Interoperability endpoints

  • Direct secure messaging: nicholas.tsanotelis.1@32866.direct.athenahealth.com

Organizations & group practices 4

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

Hospital & facility affiliations 12

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

NPI Registry JSON

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316649600000",
    "number": "1114900057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 BEDFORD ST",
            "city": "WHITMAN",
            "state": "MA",
            "postal_code": "023821859",
            "telephone_number": "781-792-6000",
            "fax_number": "781-792-6165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 BEDFORD STREET",
            "city": "WHITMAN",
            "state": "MA",
            "postal_code": "023820000",
            "telephone_number": "781-792-6000",
            "fax_number": "781-792-6165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TSANOTELIS",
        "first_name": "NICHOLAS",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-23",
        "last_updated": "2011-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "52667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3001784",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whitman, MA

Sources for this page

Verify at the official NPI Registry.