NPIMap

Individual provider Active NPI

Nicholas Philip Medeiros, PA-C

  • Physician Assistant
  • Quincy, MA
National Provider Identifier
1124646286
Registry record updated Aug 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
110 W Squantum St
Quincy, MA 02171-2122
Phone
(617) 376-3000
NPI assigned
Jul 6, 2020
Last updated
Aug 22, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

110 W Squantum St
Quincy, MA 02171-2122

Mailing address

110 W Squantum St
Quincy, MA 02171-2122
Phone (617) 376-3000

Other practice location 1

17 Concord Rd
Stoneham, MA 02180-2155
Phone (617) 967-8373

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
I20201006000767 MA Practitioner - Physician Assistant 6305265638 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

110 W Squantum St
Quincy, MA 02171-2122
Phone (617) 376-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Manet Community Health Center, Inc. CurrentSince Oct 26, 2020 Accepting new patients
Manet Community Health Center, Inc. CurrentSince Oct 26, 2020 Accepting new patients
Manet Community Health Center, Inc. Past Accepting new patients

Locations

110 W Squantum St
Quincy, MA 02171
Phone (617) 376-3000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/4368/brand/1/csg/1/fhir/r4
  • Direct secure messaging: nicholas.medeiros.1@4368.direct.athenahealth.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1593993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661126400000",
    "number": "1124646286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 W SQUANTUM ST",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021712122",
            "telephone_number": "617-376-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W SQUANTUM ST",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021712122",
            "telephone_number": "617-376-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17 Concord Rd",
            "address_purpose": "LOCATION",
            "city": "Stoneham",
            "state": "MA",
            "postal_code": "021802155",
            "country_code": "US",
            "telephone_number": "617-967-8373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDEIROS",
        "first_name": "NICHOLAS",
        "middle_name": "PHILIP",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-06",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, MA

Sources for this page

Verify at the official NPI Registry.