NPIMap

Organization Active NPI

Marblehead Ophthalmology PC

  • Ophthalmology Physician
  • Marblehead, MA
National Provider Identifier
1174201461
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MARBLEHEAD OPHTHALMOLOGY PC
Practice address
1 Widger Rd Ste 108
Marblehead, MA 01945-2100
Phone
(781) 631-8300
NPI assigned
Jul 7, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Authorized official

Name
Dr. Andrew Orenberg, MDNPI 1144754086
Title
President
Phone
(781) 696-8490

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

1 Widger Rd Ste 108
Marblehead, MA 01945-2100

Mailing address

1 Widger Rd Ste 108
Marblehead, MA 01945-2100
Phone (781) 696-8490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240102002922 MA Part B Supplier - Clinic/Group Practice 2365892445 Receives reassigned benefits from 2 practitioners
Practice locations: Marblehead, MA

National Provider Directory

National Provider Directory

Locations

1 Widger Rd
Ste 108
Marblehead, MA 01945
Phone (781) 631-8300

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1688688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688688000000",
    "number": "1174201461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WIDGER RD STE 108",
            "city": "MARBLEHEAD",
            "state": "MA",
            "postal_code": "019452100",
            "telephone_number": "781-696-8490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WIDGER RD STE 108",
            "city": "MARBLEHEAD",
            "state": "MA",
            "postal_code": "019452100",
            "telephone_number": "781-631-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARBLEHEAD OPHTHALMOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-07",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A",
        "authorized_official_last_name": "ORENBERG",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-696-8490",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marblehead, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2023; 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.

Verify at the official NPI Registry.