Mystic Medical Group, Inc.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

Legal business name

MYSTIC MEDICAL GROUP, INC.

Practice address

170 Governors Ave
Medford, MA 02155-1643

Phone

(781) 391-4106

Fax

(781) 391-3043

NPI assigned

Jan 5, 2006

Last updated

Oct 21, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Robert S Weinstein, M.D.NPI 1801887831

Title

President

Phone

(781) 391-0801

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

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.

• Robert S Weinstein, MD

  • Internal Medicine Physician
  • Medford, MA
  • NPI 1801887831
  Medicare reassignment NPD Authorized official
• David S. Pladziewicz, MD MBA

  • Cardiovascular Disease Physician
  • Medford, MA
  • NPI 1710950449
  NPD (past)

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287619200000",
    "number": "1245218676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 GOVERNORS AVE",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021551643",
            "telephone_number": "781-391-0801",
            "fax_number": "781-391-3793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 GOVERNORS AVE",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021551643",
            "telephone_number": "781-391-4106",
            "fax_number": "781-391-3043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-05",
        "last_updated": "2010-10-21",
        "status": "A",
        "authorized_official_last_name": "WEINSTEIN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-391-0801",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP",
            "identifier": "M17957",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS GROUP",
            "identifier": "688708",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nerminka Muslija
• Mwhlpho
• Anitra N Myers, LMHC
• John A Myers, M.D.
• Mystic Cardiology Associates Inc
• Mystic Valley Chiropractic Office, P.C.
• Mystic Valley Dermatology Associates, P.C.
• Mystic Valley Medical Associates Inc.
• Mystic Valley Orthodontics
• Mystick Women's Health, Inc.

• Pulmonary Disease Physician in Medford, MA
• Providers in Medford, MA by specialty
• Pulmonary Disease Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.