NPIMap

Organization Active NPI

David E Eisenberg MD PC

  • Ophthalmology Physician
  • Chelsea, MA
National Provider Identifier
1235156282
Registry record updated Nov 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
36137 Issued in MA
Legal business name
DAVID E EISENBERG MD PC
Practice address
111 Everett Ave
Ste 2C
Chelsea, MA 02150
Phone
(617) 884-0456
Fax
(617) 884-0457
NPI assigned
Jul 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2016

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

Authorized official

Name
David Ellis Eisenberg, MDNPI 1376582379
Title
Medical Doctor
Phone
(617) 884-0456

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
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 36137 MA Primary

Addresses

Primary practice location

111 Everett Ave
Ste 2C
Chelsea, MA 02150

Mailing address

111 Everett Ave
Ste 2C
Chelsea, MA 02150
Phone (617) 884-0456

Other identifiers 2

IdentifierTypeStateIssuer
15163OtherMAHARVARD PILGRIM
9746595MedicaidMA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120717000519 MA Part B Supplier - Clinic/Group Practice 3779795661 Receives reassigned benefits from 1 practitioner
Practice locations: Chelsea, MA

National Provider Directory

National Provider Directory

Locations

111 Everett Ave
Ste 2C
Chelsea, MA 02150
Phone (617) 884-0456

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480464000000",
    "number": "1235156282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 EVERETT AVE",
            "address_2": "STE 2C",
            "city": "CHELSEA",
            "state": "MA",
            "postal_code": "02150",
            "telephone_number": "617-884-0456",
            "fax_number": "617-884-0457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 EVERETT AVE",
            "address_2": "STE 2C",
            "city": "CHELSEA",
            "state": "MA",
            "postal_code": "02150",
            "telephone_number": "617-884-0456",
            "fax_number": "617-884-0457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID E EISENBERG MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2016-11-30",
        "status": "A",
        "authorized_official_last_name": "EISENBERG",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ELLIS",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "617-884-0456",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "MA",
            "license": "36137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "15163",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9746595",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chelsea, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; 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.