NPIMap

Organization Active NPI

Mendes Medical Assoc. PC

  • Internal Medicine Physician
  • Roslindale, MA
National Provider Identifier
1225212335
Registry record updated Jul 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
80176 Issued in MA
Legal business name
MENDES MEDICAL ASSOC. PC
Practice address
55 Belgade Ave
Roslindale, MA 02131-2413
Phone
(617) 327-7465
Fax
(617) 363-9993
NPI assigned
Dec 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2012

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

Authorized official

Name
Dr. Antonio C Mendes, M.DNPI 1659347961
Title
Medical Director
Phone
(617) 327-7465

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 80176
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 80176 MA Primary

Addresses

Primary practice location

55 Belgade Ave
Roslindale, MA 02131-2413

Mailing address

55 Belgrade Ave
Roslindale, MA 02131-2413
Phone (617) 327-7465

Other identifiers 3

IdentifierTypeStateIssuer
9729259MedicaidMA
M19669OtherMABCBS
110069096AMedicaidMA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080912000334 MA Part B Supplier - Clinic/Group Practice 8022184225 Receives reassigned benefits from 1 practitioner
Practice locations: Norwood, MA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1198627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343692800000",
    "number": "1225212335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 BELGRADE AVE",
            "city": "ROSLINDALE",
            "state": "MA",
            "postal_code": "021312413",
            "telephone_number": "617-327-7465",
            "fax_number": "617-363-9993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 BELGADE AVE",
            "city": "ROSLINDALE",
            "state": "MA",
            "postal_code": "021312413",
            "telephone_number": "617-327-7465",
            "fax_number": "617-363-9993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDES MEDICAL ASSOC. PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-26",
        "last_updated": "2012-07-31",
        "status": "A",
        "authorized_official_last_name": "MENDES",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "617-327-7465",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": "80176",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "80176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9729259",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "M19669",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110069096A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roslindale, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2012; 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.