NPIMap

Individual provider Active NPI

Deirdre M Connolly, MD

  • Family Medicine Physician
  • Chelmsford, MA
National Provider Identifier
1124076120
Registry record updated Apr 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
205858 Issued in MA
Practice address
23 Village SQ
Chelmsford, MA 01824-2712
Phone
(978) 323-2835
Fax
(978) 323-2836
NPI assigned
May 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 205858 MA Primary

Addresses

Primary practice location

23 Village SQ
Chelmsford, MA 01824-2712

Mailing address

23 Village SQ
Chelmsford, MA 01824-2712
Phone (978) 323-2835

Other identifiers 1

IdentifierTypeStateIssuer
9771298MedicaidMA

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
I20040203000631 MA Practitioner - Family Practice 4385537539 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rush Medical College of Rush University, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
LGH Medical Group, Inc.Group PAC ID 3173626751, 165 clinicians

Practice addresses (Care Compare)

23 Village SQ
Chelmsford, MA 01824-2712
Phone (978) 256-3702

Hospital & facility affiliations

  • Tufts Medicine Care at Home Home health agency, Lowell, MA, CCN 227206
  • Pathways Healthcare Home health agency, Westwood, MA, CCN 227569
  • Amedisys Home Health Care Home health agency, Wakefield, MA, CCN 227211
  • Lowell General Hospital Hospital, Lowell, MA, CCN 220063
  • Melrosewakefield Healthcare Hospital, Melrose, MA, CCN 220070
  • Lahey Hospital & Medical Center, Burlington Hospital, Burlington, MA, CCN 220171
  • Northeast Rehabilitation Hospital Inpatient rehabilitation facility, Salem, NH, CCN 303026

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
LGH Medical Group, Inc. Family Medicine CurrentSince Oct 12, 2010 Accepting new patients
LGH Physician Associates, Inc Family Medicine Past Accepting new patients
LGH Professional Services LLC Past Accepting new patients

Locations

23 Village Sq
Chelmsford, MA 01824
Phone (978) 256-3702

1 Meeting House Rd
Ste 5
Chelmsford, MA 01824
Phone (508) 667-8200

295 Varnum Ave
Lowell, MA 01854
Phone (978) 788-7344

10 Research Pl
Ste 200
North Chelmsford, MA 01863
Phone (978) 323-7085

600 Clark Rd
Fl 2
Tewksbury, MA 01876
Phone (978) 453-1811

600 Clark Rd
Tewksbury, MA 01876
Phone (978) 452-3453

Organizations & group practices 3

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 7

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": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491177600000",
    "number": "1124076120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 VILLAGE SQ",
            "city": "CHELMSFORD",
            "state": "MA",
            "postal_code": "018242712",
            "telephone_number": "978-323-2835",
            "fax_number": "978-323-2836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 VILLAGE SQ",
            "city": "CHELMSFORD",
            "state": "MA",
            "postal_code": "018242712",
            "telephone_number": "978-323-2835",
            "fax_number": "978-323-2836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "DEIRDRE",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2017-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "205858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9771298",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chelmsford, MA

Sources for this page

Verify at the official NPI Registry.