Nicholas Philip Medeiros, PA-C
Individual provider Active NPI Physician Assistant · Quincy, MA
NPI 1124646286 · NPPES record last updated Aug 22, 2022
Key facts
- NPI
- 1124646286
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 110 W Squantum St
Quincy, MA 02171-2122 - Phone
- (617) 376-3000
- NPI assigned
- Jul 6, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Manet Community Health Center, Inc.
Practice addresses (Care Compare)
110 W Squantum St
Quincy, MA 02171-2122
Phone (617) 376-3000
Hospital & facility affiliations
- South Shore Visiting Nurse Association
- Pathways Healthcare
- Croi Health
- South Shore Hospital
- Beth Israel Deaconess Hospital - Milton
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201006000767 | MA | Practitioner - Physician Assistant | 6305265638 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Manet Community Health Center, Inc. | Current |
Accepting new patients | |
| DRX UC Watertown PC | Current |
Accepting new patients | |
| Manet Community Health Center, Inc. | Current |
Accepting new patients | |
| Manet Community Health Center, Inc. | Past | Accepting new patients |
Locations
110 W Squantum St
Quincy, MA 02171
Phone (617) 376-3000
376 Arsenal St
Watertown, MA 02472
Phone (617) 923-2273
Interoperability endpoints
- https://api.platform.athenahealth.com/4368/brand/1/csg/1/fhir/r4
- nicholas.medeiros.1@4368.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
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
Other providers in Quincy, MA
- Sarah Ann McSweeney-Ryan
- Lauren Meatty
- Med Rac'S
- Med Staffing, Inc.
- Carissa Lynne Medeiros
- Medi-Son Solutions, LLC
- Sashaann Medina
- Megan Margaret Meehan
- Meg Mahoney Nutrition LLC
- Meg Mahoney Nutrition LLC
All providers in Quincy, MA · Physician Assistant in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.