Active NPI
Merrimack Valley Medical Associates, PC
- Internal Medicine Physician
- Methuen, MA
National Provider Identifier
1114914868
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 155341
- Legal business name
- MERRIMACK VALLEY MEDICAL ASSOCIATES, PC
- Practice address
- 421 Merrimack St
Suite 201
Methuen, MA 01844-5803 - Phone
- (978) 725-4822
- Fax
- (978) 725-5277
- NPI assigned
- Sep 27, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Leo William Lane, D.O.
- Title
- Owner
- Phone
- (978) 725-4822
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 155341 | MA | Primary |
Addresses
Primary practice location
421 Merrimack St
Suite 201
Methuen, MA 01844-5803
Mailing address
PO Box 3160
Andover, MA 01810-0803
Phone (978) 289-1188
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2301962 | Other | MA | AETNA US HEALTH |
| 3208621 | Medicaid | MA | |
| 50493 | Other | MA | MATTHEW THORNTON |
| 9593735010 | Other | MA | CIGNA |
| 504290 | Other | MA | CIGNA HEALTHSOURCE |
| 155341 | Other | MA | TUFTS |
| 69499 | Other | MA | HARVARD PILGRIM |
| 2301962 | Other | MA | US HEALTH |
| 49241 | Other | MA | FALLON |
| 504290 | Other | MA | HEALTH SOURCE |
| M18024 | Other | MA | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
300 Brickstone Sq
Ste 101
Andover, MA 01810
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EHJJAA
Practitioners & affiliated clinicians
Practitioners 7
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Methuen, MA
- NPI 1770570426
-
- Family Nurse Practitioner
- Methuen, MA
- NPI 1801403043
-
- Family Nurse Practitioner
- Lowell, MA
- NPI 1851947931
-
- Adult Health Nurse Practitioner
- Burlington, MA
- NPI 1194135111
-
- Nurse Practitioner
- Boston, MA
- NPI 1457875007
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127779200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1632787200000",
"number": "1114914868",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3160",
"city": "ANDOVER",
"state": "MA",
"postal_code": "018100803",
"telephone_number": "978-289-1188",
"fax_number": "978-474-8845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "421 MERRIMACK ST",
"address_2": "SUITE 201",
"city": "METHUEN",
"state": "MA",
"postal_code": "018445803",
"telephone_number": "978-725-4822",
"fax_number": "978-725-5277"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MERRIMACK VALLEY MEDICAL ASSOCIATES, PC",
"organizational_subpart": "NO",
"enumeration_date": "2005-09-27",
"last_updated": "2021-09-28",
"certification_date": "2021-09-28",
"status": "A",
"authorized_official_last_name": "LANE",
"authorized_official_first_name": "LEO",
"authorized_official_middle_name": "WILLIAM",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "978-725-4822",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.O."
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": "MA",
"license": "155341",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA US HEALTH",
"identifier": "2301962",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3208621",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MATTHEW THORNTON",
"identifier": "50493",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "9593735010",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA HEALTHSOURCE",
"identifier": "504290",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "155341",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "69499",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "US HEALTH",
"identifier": "2301962",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FALLON",
"identifier": "49241",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH SOURCE",
"identifier": "504290",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "M18024",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Methuen, MA
- Melan Wellness, LLC
- Claire Melley
- Jessica Mendez, BSN
- Merrimack Dental Assoc., PC
- Merrimack Valley Counseling Center
- Merrimack Valley Nephrology,Hypertension,& Internal Medicine,PC
- Merrimack Valley Pet PC
- Merrimack Valley Radiation Oncology Associates, LLC
- Merrimack Valley Women'S Health Services
- Ryan James Messier, RN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.