Active NPI
Advantage Surgical and Wound Care Massachusetts PC
- Surgery Physician
- Revere, MA
National Provider Identifier
1164039152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- ADVANTAGE SURGICAL AND WOUND CARE MASSACHUSETTS PC
- Practice address
- 204 Proctor Ave
Revere, MA 02151-4923 - Phone
- (877) 878-3289
- Fax
- (877) 817-3227
- NPI assigned
- Sep 24, 2020
- Last updated
- Sep 24, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- John Griffin, MD
- Title
- President
- Phone
- (877) 878-3289
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Undersea and Hyperbaric Medicine (Emergency Medicine) Physician | 207PE0005X | |||
| Surgery Physician | 208600000X | Primary |
Addresses
Primary practice location
204 Proctor Ave
Revere, MA 02151-4923
Mailing address
222 N Pacific Coast Hwy Ste 2175
El Segundo, CA 90245-5639
Phone (877) 878-3289
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
108 Littleton Rd
#111
Westford, MA 01886
Phone (978) 320-3383
Practitioners & affiliated clinicians
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Nurse Practitioner
- Boston, MA
- NPI 1821423237
-
- Family Nurse Practitioner
- Quincy, MA
- NPI 1497184873
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600905600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1600905600000",
"number": "1164039152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 N PACIFIC COAST HWY STE 2175",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902455639",
"telephone_number": "877-878-3289",
"fax_number": "877-817-3227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 PROCTOR AVE",
"city": "REVERE",
"state": "MA",
"postal_code": "021514923",
"telephone_number": "877-878-3289",
"fax_number": "877-817-3227"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ADVANTAGE SURGICAL AND WOUND CARE MASSACHUSETTS PC",
"organizational_subpart": "NO",
"enumeration_date": "2020-09-24",
"last_updated": "2020-09-24",
"certification_date": "2020-09-24",
"status": "A",
"authorized_official_last_name": "GRIFFIN",
"authorized_official_first_name": "JOHN",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "877-878-3289",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207PE0005X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Revere, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 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.