NPIMap

Organization Active NPI

Mikhail Novikov MD PC

Doing business as Dr. Novikov Wellness and Skin Care

  • Surgery Physician
  • Northborough, MA
National Provider Identifier
1124418058
Registry record updated Mar 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
241998 Issued in MA
Legal business name
MIKHAIL NOVIKOV MD PC
Doing business as
Dr. Novikov Wellness and Skin Care
Practice address
318 Main Street
Northborough, MA 01532
Phone
(508) 936-1657
Fax
(888) 355-3778
NPI assigned
Jan 30, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2020

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

Authorized official

Name
Mikhail Novikov, M.D.NPI 1629278221
Title
Medical Director
Phone
(508) 936-1657

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)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 241998 MA Primary

Addresses

Primary practice location

318 Main Street
Northborough, MA 01532

Mailing address

10 Thaddeus Mason Rd
Northborough, MA 01532-2284
Phone (617) 209-7823

Other identifiers 1

IdentifierTypeStateIssuer
110109342AMedicaidMA

Other names 1

  • Dr. Novikov Wellness and Skin Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150720002444 MA Part B Supplier - Clinic/Group Practice 4981917952 Receives reassigned benefits from 10 practitioners
Practice locations: Northborough, MA; Attleboro, MA
O20170222000008 NH Part B Supplier - Clinic/Group Practice 4981917952 Receives reassigned benefits from 5 practitioners
Practice locations: Nashua, NH

National Provider Directory

National Provider Directory

Locations

162 Main St
Northborough, MA 01532
Phone (508) 393-1307

318 Main St
Ste 165
Northborough, MA 01532
Phone (508) 936-1657

318 Main St
Northborough, MA 01532
Phone (508) 861-1010

150 E Main St
Unit 541
Westborough, MA 01581

255 Park Ave
Ste 600
Worcester, MA 01609
Phone (508) 756-6379

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1422576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584662400000",
    "number": "1124418058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 THADDEUS MASON RD",
            "city": "NORTHBOROUGH",
            "state": "MA",
            "postal_code": "015322284",
            "telephone_number": "617-209-7823",
            "fax_number": "617-336-3306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 MAIN STREET",
            "city": "NORTHBOROUGH",
            "state": "MA",
            "postal_code": "01532",
            "telephone_number": "508-936-1657",
            "fax_number": "888-355-3778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKHAIL NOVIKOV MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-30",
        "last_updated": "2020-03-20",
        "certification_date": "2020-03-20",
        "status": "A",
        "authorized_official_last_name": "NOVIKOV",
        "authorized_official_first_name": "MIKHAIL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "508-936-1657",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "MA",
            "license": "241998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110109342A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Novikov Wellness and Skin Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Northborough, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2020; 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.

Verify at the official NPI Registry.