NPIMap

Individual provider Active NPI

Kenneth Kenji Tanabe, MD

  • Surgery Physician
  • Boston, MA
National Provider Identifier
1164413613
Registry record updated Nov 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
78104 Issued in MA
Practice address
55 Fruit St
Yaw 7B
Boston, MA 02114-2621
Phone
(617) 724-3868
Fax
(617) 724-3895
NPI assigned
Nov 3, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 78104 MA Primary

Addresses

Primary practice location

55 Fruit St
Yaw 7B
Boston, MA 02114-2621

Mailing address

PO Box 9142
Charlestown, MA 02129-9142
Phone (617) 724-0287

Other identifiers 3

IdentifierTypeStateIssuer
3114015MedicaidMA
J13876OtherMABCBS MA
078104OtherMATUFTS HEALTH PLAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, ME2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040707000244 MA Practitioner - Surgical OncologyPractitioner - General Surgery 2860479953 Reassigns benefits to 3 organizations
I20230421000510 ME Practitioner - General Surgery 2860479953 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Surgical OncologyAlso: General Surgery
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The General Hospital CorporationGroup PAC ID 6507803806, 1,275 clinicians

Practice addresses (Care Compare)

55 Fruit St
Boston, MA 02114-2621
Phone (617) 726-2000

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision87

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
LGH Medical Group, Inc. CurrentSince Apr 7, 2018 Accepting new patients
Central Maine Medical Center CurrentSince Mar 28, 2023 Accepting new patients
Rumford Hospital CurrentSince Mar 28, 2023 Accepting new patients
Rumford Hospital CurrentSince Mar 28, 2023 Accepting new patients
The General Hospital Corporation CurrentSince Jul 23, 1993 Accepting new patients
Bridgton Hospital CurrentSince Mar 28, 2023 Accepting new patients
Bridgton Hospital CurrentSince Mar 28, 2023 Accepting new patients
Massachusetts General Physicians Organization Inc Surgery CurrentSince Jul 23, 1993 Accepting new patients
Central Maine Medical Center CurrentSince Mar 28, 2023 Accepting new patients
General Hospital Corp Current Accepting new patients
Central Maine Medical Center Current Accepting new patients
LGH Professional Services LLC Past Accepting new patients

Locations

55 Fruit St
Ste B
Boston, MA 02114

55 Fruit St
#7B
Boston, MA 02114
Phone (617) 726-8290

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

55 Fruit St
Boston, MA 02114

100 Blossom St
#646
Boston, MA 02114
Phone (617) 724-3868

295 Varnum Ave
Lowell, MA 01854
Phone (978) 788-7344

52 Second Ave
Ste 2500
Waltham, MA 02451
Phone (781) 487-2200

10 Hospital Dr
Bridgton, ME 04009
Phone (207) 647-6000

300 Main St
Lewiston, ME 04240
Phone (207) 795-2400

420 Franklin St
Rumford, ME 04276
Phone (207) 364-4581

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/4517c430-03bf-4e32-b324-1387cc4e73f3/
  • Direct secure messaging: ktanabe31479@tuftsmedicine.direct-ci.com
  • Direct secure messaging: tanabe.kenneth.mgh@direct.partners.masshiway.net

Organizations & group practices 12

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.

Hospital & facility affiliations 3

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": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352160000000",
    "number": "1164413613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9142",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021299142",
            "telephone_number": "617-724-0287",
            "fax_number": "617-726-2894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "address_2": "YAW 7B",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-724-3868",
            "fax_number": "617-724-3895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANABE",
        "first_name": "KENNETH",
        "middle_name": "KENJI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2012-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "78104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3114015",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MA",
            "identifier": "J13876",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "078104",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.