NPIMap

Organization Active NPI

Gary Mendese, MD, LLC

  • Procedural Dermatology Physician
  • Peabody, MA
National Provider Identifier
1194341362
Registry record updated Jun 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
Legal business name
GARY MENDESE, MD, LLC
Practice address
23 Centennial Dr
Peabody, MA 01960-7901
Phone
(978) 531-7677
NPI assigned
Jun 23, 2020
Last updated
Jun 23, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2020

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

Authorized official

Name
Gary Mendese, MDNPI 1780851386
Title
President
Phone
(978) 235-1063

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
Procedural Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207NS0135X Primary

Addresses

Primary practice location

23 Centennial Dr
Peabody, MA 01960-7901

Mailing address

15 Candlewood Rd
Lynnfield, MA 01940-2437

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210111000206 MA Part B Supplier - Clinic/Group Practice 8123431210 Receives reassigned benefits from 6 practitioners
Practice locations: Beverly, MA; Peabody, MA

National Provider Directory

National Provider Directory

Locations

23 Centennial Dr
Peabody, MA 01960
Phone (978) 525-0100

27 Centennial Dr
Peabody, MA 01960
Phone (978) 531-7677

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1592870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592870400000",
    "number": "1194341362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 CANDLEWOOD RD",
            "city": "LYNNFIELD",
            "state": "MA",
            "postal_code": "019402437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 CENTENNIAL DR",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019607901",
            "telephone_number": "978-531-7677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY MENDESE, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-23",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A",
        "authorized_official_last_name": "MENDESE",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-235-1063",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peabody, MA

Sources for this page

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

Verify at the official NPI Registry.