NPIMap

Organization Active NPI

Woburn Pediatric Associates

  • Pediatrics Physician
  • Woburn, MA
National Provider Identifier
1124136510
Registry record updated Sep 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
WOBURN PEDIATRIC ASSOCIATES
Practice address
7 Alfred St
Baldwin Park II
Woburn, MA 01801-1976
Phone
(781) 933-6236
Fax
(781) 938-8050
NPI assigned
Aug 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2016

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

Authorized official

Name
John Petrarca
Title
Executive Director
Phone
(781) 638-1020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

7 Alfred St
Baldwin Park II
Woburn, MA 01801-1976

Mailing address

7 Alfred St
Baldwin Park II
Woburn, MA 01801-1976
Phone (781) 933-6236

Other identifiers 6

IdentifierTypeStateIssuer
9712623MedicaidMA
25114OtherMAFALLON
805422OtherMATUFTS HEALTH PLAN - LAB
M12470OtherMABLUE CROSS BLUE SHIELD
600388OtherMATUFTS HEALTH PLAN
9110OtherMAAETNA/US HEALTHCARE

Other names 1

  • North Andover Pediatric Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121220000233 MA Part B Supplier - Clinic/Group Practice 5294822540 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
Practice locations: North Andover, MA; Woburn, MA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
22D0071165Woburn Pediatric Associates7 Alfred St, Woburn, MA 01801ComplianceSep 15, 2027

National Provider Directory

National Provider Directory

Locations

800 Turnpike St
Ofc Par
North Andover, MA 01845
Phone (978) 557-5712

805 Turnpike St
Ste 202
North Andover, MA 01845
Phone (978) 689-0621

805 Turnpike St
North Andover, MA 01845
Phone (978) 686-2900

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474243200000",
    "number": "1124136510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 ALFRED ST",
            "address_2": "BALDWIN PARK II",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011976",
            "telephone_number": "781-933-6236",
            "fax_number": "781-938-8050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 ALFRED ST",
            "address_2": "BALDWIN PARK II",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011976",
            "telephone_number": "781-933-6236",
            "fax_number": "781-938-8050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOBURN PEDIATRIC ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-27",
        "last_updated": "2016-09-19",
        "status": "A",
        "authorized_official_last_name": "PETRARCA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "781-638-1020"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9712623",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON",
            "identifier": "25114",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN - LAB",
            "identifier": "805422",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "M12470",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "600388",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA/US HEALTHCARE",
            "identifier": "9110",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Andover Pediatric Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woburn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2016; 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.