NPIMap

Individual provider Active NPI

Boutros Michel Ghassibi, MD

  • Sports Medicine (Family Medicine) Physician
  • Lawrence, MA
National Provider Identifier
1184723819
Registry record updated Nov 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
72138 Issued in MA
Practice address
34 Haverhill St
Lawrence, MA 01841-2884
Phone
(978) 686-0090
Fax
(978) 681-5963
NPI assigned
Sep 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 9, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 72138 MA
Sports Medicine (Family Medicine) Physician 207QS0010X 72138 MA Primary

Addresses

Primary practice location

34 Haverhill St
Lawrence, MA 01841-2884

Mailing address

34 Haverhill St
Lawrence, MA 01841-2884
Phone (978) 686-0090

Other identifiers 1

IdentifierTypeStateIssuer
3166724MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
72138MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nelson J Matos, D.O., P.L.L.C. Past Accepting new patients
Andover Obstetrics and Gynecological Associates, PC Past Accepting new patients
Community Medical Associates, Inc. Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510185600000",
    "number": "1184723819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 HAVERHILL ST",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018412884",
            "telephone_number": "978-686-0090",
            "fax_number": "978-681-5963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 HAVERHILL ST",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018412884",
            "telephone_number": "978-686-0090",
            "fax_number": "978-681-5963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHASSIBI",
        "first_name": "BOUTROS",
        "middle_name": "MICHEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2017-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "72138",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MA",
            "license": "72138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3166724",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrence, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.