Active NPI
David W Douglas, MD
- Family Medicine Physician
- Lynn, MA
National Provider Identifier
1154340420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 150082
- Practice address
- 330 Lynnway
Suite 109a
Lynn, MA 01901-1706 - Phone
- (781) 593-6005
- Fax
- (781) 593-1370
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 150082 | MA | Primary |
Addresses
Primary practice location
330 Lynnway
Suite 109a
Lynn, MA 01901-1706
Mailing address
330 Lynnway
Suite 109a
Lynn, MA 01901-1706
Phone (781) 593-6005
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 150082 | Other | MA | TUFTS HEALTH PLAN |
| 710790 | Other | MA | HARVARD PILGRIM |
| 3166341 | Medicaid | MA | |
| B10347002 | Other | MA | CIGNA |
| 186207 | Other | MA | HEALTHSOURCE |
| 0101449 | Other | MA | UNITED HEALTHCARE |
| J18455 | Other | MA | BC/BS |
| 2242081 | Other | MA | AETNA US HEALTHCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050721000202 | MA | Practitioner - Family Practice | 5799712782 |
Reassigns benefits to 1 organization Receives reassigned benefits from 1 practitioner Practice locations: Lynn, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Albany Medical College of Union University, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Congenial Healthcare LLC
Practice addresses (Care Compare)
330 Lynnway
Suite 109a
Lynn, MA 01901-1713
Phone (781) 593-6005
Hospital & facility affiliations
- All Care Hospice Inc
- Lahey Hospital & Medical Center, Burlington
- Northeast Hospital Corporation
- North Shore Medical Center -
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150082 | MA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Congenial Healthcare, LLC | Current | Accepting new patients | |
| David W. Douglas, MD | Family Medicine | Current | Accepting new patients |
| Congenial Healthcare, LLC | Current | Accepting new patients | |
| Congenial Healthcare, LLC | Family Medicine | Current | Accepting new patients |
| Congenial Healthcare, LLC | Past | Accepting new patients |
Locations
330 Lynnway
Ste 109A
Lynn, MA 01901
Phone (781) 593-6005
1 Roosevelt Ave
Ste 201
Peabody, MA 01960
Phone (978) 536-0215
Interoperability endpoints
- ddouglas72690@direct.bilh.masshiway.net
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
Organizations & group practices 5
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.
-
- Internal Medicine Physician
- Wakefield, MA
- NPI 1033620372
-
- Internal Medicine Physician
- Peabody, MA
- NPI 1790241735
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": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154340420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 LYNNWAY",
"address_2": "SUITE 109A",
"city": "LYNN",
"state": "MA",
"postal_code": "019011706",
"telephone_number": "781-593-6005",
"fax_number": "781-593-1370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 LYNNWAY",
"address_2": "SUITE 109A",
"city": "LYNN",
"state": "MA",
"postal_code": "019011706",
"telephone_number": "781-593-6005",
"fax_number": "781-593-1370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "DAVID",
"middle_name": "W",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MA",
"license": "150082",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "150082",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "710790",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3166341",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "B10347002",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHSOURCE",
"identifier": "186207",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "0101449",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "J18455",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA US HEALTHCARE",
"identifier": "2242081",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lynn, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.