NPIMap

Individual provider Active NPI

Mai Truc Phan, MD

  • Family Medicine Physician
  • Boston, MA
National Provider Identifier
1255321998
Registry record updated Nov 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
153182 Issued in MA
Practice address
388 Commonwelath Ave MBB
MGH Back Bay
Boston, MA 02215-2800
Phone
(617) 267-7171
Fax
(617) 262-2608
NPI assigned
Oct 25, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 153182 MA Primary

Addresses

Primary practice location

388 Commonwelath Ave MBB
MGH Back Bay
Boston, MA 02215-2800

Mailing address

PO Box 9142
Mass General Physician Organization
Charlestown, MA 02129-9142
Phone (617) 267-7171

Other identifiers 3

IdentifierTypeStateIssuer
3167488MedicaidMA
J17866OtherMABCBS MA
153182OtherMATUFTS HEALTH PLAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040503001345 MA Practitioner - Family Practice 3971591553 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The General Hospital CorporationGroup PAC ID 6507803806, 1,275 clinicians

Practice addresses (Care Compare)

388 Commonwealth Ave
Boston, MA 02215-2800
Phone (617) 267-7171

55 Fruit St
Boston, MA 02114-2621
Phone (617) 726-2000

Hospital & facility affiliations

  • Mass General Brigham Home Care, Inc Home health agency, Newton, MA, CCN 227207
  • Massachusetts General Hospital Hospital, Boston, MA, CCN 220071
  • Brigham and Women'S Hospital Hospital, Boston, MA, CCN 220110
  • Brigham and Women Faulkner Hospital Hospital, Jamaica Plain, MA, CCN 220119
  • North Shore Medical Center - Hospital, Salem, MA, CCN 220035
  • Massachusetts Eye and Ear Infirmary - Hospital, Boston, MA, CCN 220075

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
153182MAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Massachusetts General Physicians Organization Inc CurrentSince Jun 4, 1997 Accepting new patients
General Hospital Corp Current Accepting new patients
The General Hospital Corporation CurrentSince Oct 1, 2006 Accepting new patients

Locations

388 Commonwealth Ave
Ste B2
Boston, MA 02215

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

388 Commonwealth Ave
Boston, MA 02215
Phone (617) 267-7171

Interoperability endpoints

  • Direct secure messaging: phan.mai.mgh@direct.partners.masshiway.net

Organizations & group practices 3

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 7

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": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353888000000",
    "number": "1255321998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9142",
            "address_2": "MASS GENERAL PHYSICIAN ORGANIZATION",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021299142",
            "telephone_number": "617-267-7171",
            "fax_number": "617-262-2608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "388 COMMONWELATH AVE MBB",
            "address_2": "MGH BACK BAY",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022152800",
            "telephone_number": "617-267-7171",
            "fax_number": "617-262-2608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "MAI",
        "middle_name": "TRUC",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-25",
        "last_updated": "2012-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "153182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3167488",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MA",
            "identifier": "J17866",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "153182",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.