NPIMap

Individual provider Active NPI

Dominic D Pennachio, M.D.

  • Internal Medicine Physician
  • Chestnut Hill, MA
National Provider Identifier
1194830158
Registry record updated Jun 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
56237 Issued in MA
Practice address
25 Boylston St
Suite 204
Chestnut Hill, MA 02467-1715
Phone
(617) 754-0400
NPI assigned
Aug 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 56237 MA Primary

Addresses

Primary practice location

25 Boylston St
Suite 204
Chestnut Hill, MA 02467-1715

Mailing address

25 Boylston St Ste 204
Chestnut Hill, MA 02467-1710
Phone (617) 754-0400

Other identifiers 2

IdentifierTypeStateIssuer
J06834OtherMABLUE CROSS
3025691MedicaidMA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050401000323 MA Practitioner - Internal Medicine 7214984202 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Yale University School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians
Medical Care of Boston Management CorporationGroup PAC ID 6800787714, 293 clinicians

Practice addresses (Care Compare)

2600 Compass Rd
Glenview, IL 60026-8001

93 Pond St
Sharon, MA 02067-2015
Phone (781) 784-9212

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56237MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Care of Boston Management Corporation Internal Medicine CurrentSince Jul 23, 1987 Accepting new patients

Locations

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

25 Boylston St
Chestnut Hill, MA 02467
Phone (617) 277-2399

25 Boylston St
Ste 204
Chestnut Hill, MA 02467
Phone (617) 232-8777

93 Pond St
Sharon, MA 02067
Phone (781) 784-9212

247 Station Dr
Ste NW1
Westwood, MA 02090
Phone (617) 754-1015

Interoperability endpoints

  • Direct secure messaging: dpennachio338861@direct.bilh.masshiway.net

Organizations & group practices 2

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 10

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": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212537600000",
    "number": "1194830158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 BOYLSTON ST STE 204",
            "city": "CHESTNUT HILL",
            "state": "MA",
            "postal_code": "024671710",
            "telephone_number": "617-754-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 BOYLSTON ST",
            "address_2": "SUITE 204",
            "city": "CHESTNUT HILL",
            "state": "MA",
            "postal_code": "024671715",
            "telephone_number": "617-754-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNACHIO",
        "first_name": "DOMINIC",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2008-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "56237",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "J06834",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3025691",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chestnut Hill, MA

Sources for this page

Verify at the official NPI Registry.