NPIMap

Organization Active NPI

Concord OB/GYN Associates PC

  • Obstetrics & Gynecology Physician
  • Concord, MA
National Provider Identifier
1114919313
Registry record updated Oct 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
CONCORD OB/GYN ASSOCIATES PC
Practice address
59 Ornac
Suite 1
Concord, MA 01742-3317
Phone
(978) 369-7627
Fax
(976) 371-2240
NPI assigned
Aug 16, 2005
Last updated
Oct 29, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2008

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

Authorized official

Name
Avra Jordano-Alter, M.D.NPI 1104818392
Title
President
Phone
(978) 369-7627

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X NU Primary

Addresses

Primary practice location

59 Ornac
Suite 1
Concord, MA 01742-3317

Mailing address

59 Ornac
Suite 1
Concord, MA 01742-3317
Phone (978) 369-7627

Other identifiers 1

IdentifierTypeStateIssuer
9725733MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040923000572 MA Part B Supplier - Clinic/Group Practice 0941278261 Receives reassigned benefits from 10 practitioners
Practice locations: Concord, 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
22D1008067Concord OB/GYN Assoc PC59 Ornac Ste 1, W Concord, MA 01742Provider-performed microscopyJan 8, 2027

National Provider Directory

National Provider Directory

Locations

59 Old Road To 9 Acre Cor
#1
Concord, MA 01742
Phone (978) 369-7627

59 Ornac
#1
Concord, MA 01742
Phone (978) 369-7627

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225238400000",
    "number": "1114919313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 ORNAC",
            "address_2": "SUITE 1",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017423317",
            "telephone_number": "978-369-7627",
            "fax_number": "976-371-2240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 ORNAC",
            "address_2": "SUITE 1",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017423317",
            "telephone_number": "978-369-7627",
            "fax_number": "976-371-2240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCORD OB/GYN ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2008-10-29",
        "status": "A",
        "authorized_official_last_name": "JORDANO-ALTER",
        "authorized_official_first_name": "AVRA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-369-7627",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9725733",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2008; 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.