Individual provider Active NPI

Walid Ibrahim Dagher, MD

  • Otolaryngology Physician
  • Brockton, MA
National Provider Identifier
1225219173
Registry record updated Apr 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
261906 Issued in MA
Practice address
35 Pearl St Ste 100
Brockton, MA 02301-2866
Phone
(508) 588-8034
Fax
(508) 588-5969
NPI assigned
Nov 20, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 261906 MA Primary

Addresses

Primary practice location

35 Pearl St Ste 100
Brockton, MA 02301-2866

Mailing address

35 Pearl St Ste 100
Brockton, MA 02301-1195
Phone (508) 588-8034

Other identifiers 1

IdentifierTypeStateIssuer
11010386AMedicaidMA

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150814013498 MA Practitioner - Otolaryngology 6406161751 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
ENT Specialists, IncGroup PAC ID 0648353888, 20 clinicians

Practice addresses (Care Compare)

35 Pearl St
Suite 200
Brockton, MA 02301-2866
Phone (508) 588-8034

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
ENT Specialists, Inc Otolaryngology CurrentSince Aug 1, 2015 Accepting new patients
ENT Norwood LLC Otolaryngology CurrentSince Dec 3, 2018 Accepting new patients

Locations

35 Pearl St
Ste 100
Brockton, MA 02301
Phone (508) 588-8034

35 Pearl St
Ste 200
Brockton, MA 02301
Phone (508) 588-8034

333 Elm St
Dedham, MA 02026
Phone (781) 214-6590

825 Washington St
Ste 310
Norwood, MA 02062
Phone (508) 880-3460

188 Washington St
Plainville, MA 02762
Phone (508) 699-1701

72 Washington St
Ste 1600
Taunton, MA 02780
Phone (508) 880-3460

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HFADAA

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 5

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": "1195516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523923200000",
    "number": "1225219173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 PEARL ST STE 100",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023011195",
            "telephone_number": "508-588-8034",
            "fax_number": "508-588-5969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 PEARL ST STE 100",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023012866",
            "telephone_number": "508-588-8034",
            "fax_number": "508-588-5969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAGHER",
        "first_name": "WALID",
        "middle_name": "IBRAHIM",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-20",
        "last_updated": "2018-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MA",
            "license": "261906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11010386A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.