Individual provider Active NPI

Paul R. O'Brien, EDD

  • Psychologist
  • Medford, MA
National Provider Identifier
1215978895
Registry record updated Mar 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6024 Issued in MA
Practice address
26 City Hall Mall
Medford, MA 02155-4754
Phone
(781) 306-5100
NPI assigned
Jun 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6024 MA Primary

Addresses

Primary practice location

26 City Hall Mall
Medford, MA 02155-4754

Mailing address

26 City Hall Mall
Medford, MA 02155-4754
Phone (781) 306-5100

Other identifiers 2

IdentifierTypeStateIssuer
W04954OtherMABLUE CROSS
669495OtherMATUFTS HEALTH PLAN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pobrienedd9436@direct.atrius.masshiway.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101005000653 MA Practitioner - Clinical Psychologist 4587856877 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
LGH Medical Group, Inc.Group PAC ID 3173626751, 165 clinicians

Practice addresses (Care Compare)

20 Research PL
Suite 1
North Chelmsford, MA 01863-2454
Phone (978) 788-7200

295 Varnum Ave
Lowell, MA 01854-2134
Phone (978) 788-7344

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6024MAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Atrius Health, Inc. CurrentSince Oct 17, 1991 Accepting new patients
LGH Medical Group, Inc. CurrentSince Apr 5, 2017 Accepting new patients
Atrius Health, Inc. Current Accepting new patients
Atrius Health, Inc. Psychologist CurrentSince Oct 17, 1991 Accepting new patients
LGH Professional Services LLC Past Accepting new patients

Locations

147 Milk St
Fl 9
Boston, MA 02109
Phone (617) 559-8051

133 Brookline Ave
Boston, MA 02215
Phone (617) 421-1000

228 Billerica Rd
Chelmsford, MA 01824
Phone (978) 250-6000

295 Varnum Ave
Lowell, MA 01854
Phone (978) 788-7344

26 City Hall Mall
Medford, MA 02155
Phone (781) 306-5100

Interoperability endpoints

  • Direct secure messaging: pobrienedd9436@direct.atrius.masshiway.net

Organizations & group practices 5

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": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615075200000",
    "number": "1215978895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 CITY HALL MALL",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021554754",
            "telephone_number": "781-306-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 CITY HALL MALL",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021554754",
            "telephone_number": "781-306-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "PAUL",
        "middle_name": "R.",
        "credential": "EDD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2021-03-07",
        "certification_date": "2021-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "6024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "W04954",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "669495",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pobrienedd9436@direct.atrius.masshiway.net",
            "affiliation": "N",
            "address_1": "26 City Hall Mall",
            "city": "Medford",
            "state": "MA",
            "country_code": "US",
            "postal_code": "021554754",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Medford, MA

Sources for this page

Verify at the official NPI Registry.