NPIMap

Organization Active NPI

Pembroke Medical Associates Inc

  • Internal Medicine Physician
  • Pembroke, MA
National Provider Identifier
1194332759
Registry record updated Feb 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PEMBROKE MEDICAL ASSOCIATES INC
Practice address
15 Old West Elm St
Pembroke, MA 02359-1731
Phone
(781) 718-7435
NPI assigned
Sep 28, 2020
Last updated
Feb 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2023

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

Authorized official

Name
Dr. John Michael Stevenson, MDNPI 1043284789
Title
President
Phone
(781) 202-9292

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
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

15 Old West Elm St
Pembroke, MA 02359-1731

Mailing address

15 Old West Elm St
Pembroke, MA 02359-1731
Phone (781) 202-9292

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201006002422 MA Part B Supplier - Clinic/Group Practice 3678992955 Receives reassigned benefits from 27 practitioners
Practice locations: Pembroke, MA; Plymouth, MA; Quincy, MA; Scituate, MA; Weymouth, MA; Norwell, MA; Braintree, MA; Dorchester, MA…

National Provider Directory

National Provider Directory

Locations

1102 Washington St
Braintree, MA 02184
Phone (781) 794-5406

2049 Dorchester Ave
Dorchestr Ctr, MA 02124
Phone (617) 825-3905

50 Recreation Park Dr
Hingham, MA 02043
Phone (781) 635-3001

Practitioners & affiliated clinicians

Practitioners 29

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.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1601251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677110400000",
    "number": "1194332759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 OLD WEST ELM ST",
            "city": "PEMBROKE",
            "state": "MA",
            "postal_code": "023591731",
            "telephone_number": "781-202-9292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 OLD WEST ELM ST",
            "city": "PEMBROKE",
            "state": "MA",
            "postal_code": "023591731",
            "telephone_number": "781-718-7435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEMBROKE MEDICAL ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-28",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A",
        "authorized_official_last_name": "STEVENSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-202-9292",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 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.