Individual provider Active NPI

Lester P Mietkiewicz, MD

Internal Medicine Physician
Worcester, MA

National Provider Identifier

1285609479

Registry record updated Aug 3, 2021

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
Organizations & group practices2
NPI Registry JSON
Other providers in Worcester, MA
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Internal Medicine PhysicianTaxonomy code 207R00000X
License: 49809 Issued in MA
Practice address: 367 Plantation St
Worcester, MA 01605-2323
Phone: (508) 334-1448
Fax: (508) 334-1443
NPI assigned: Feb 21, 2006
Sex: Male
Sole proprietor: No

NPPES NPI Registry

Updated by the provider on Aug 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)	Code	License	State	Primary
Internal Medicine Physician	207R00000X	49809	MA	Primary

Addresses

Primary practice location

367 Plantation St
Worcester, MA 01605-2323

Mailing address

PO Box 415348
Boston, MA 02241-5348
Phone (800) 225-8885

Other identifiers 17

Identifier	Type	State	Issuer
042472266	Other		ONE HEALTH PLAN
4034906	Other		AETNA US HEALTHCARE
8239846	Other		CIGNA HEALTH PLAN
J02901	Other		BLUE SHIELD INDEMNITY
0400875	Other		EVERCARE
28035	Other		HEALTHY START
9900029	Other		FALLON COMMUNITY HEALTH
AA1293	Other		HARVARD PILGRIM HEALTHCAR
J02901	Other		BLUE CARE ELECT
28035	Other		CHILDRENS MEDICAL
043058466	Other		HEALTHCARE VALUE MANAGEME
J02901	Other		BLUE SHIELD HMO BLUE
784252	Other		MVP HEALTH CARE
934972	Other		FIRST HEALTH
042472266	Other		THREE RIVERS
042472266	Other		PRIVATE HEALTHCARE
6180493	Medicaid	MA

Electronic endpoints 2

Type	Endpoint	Use	Affiliation
Direct Messaging Address	lmietkiewicz23311@UmassMemorial.direct-ci.com
FHIR URL	https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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 ID	State	Provider type	PAC ID	Details
I20050324000952	MA	Practitioner - Internal Medicine	8820044662

National Provider Directory

Medicare enrollment (NPD): Enrolled
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
49809	MA	MD	Internal Medicine Physician

Practice roles

Organization	Specialty	Status	New patients
Reliant Medical Group, Inc	Internal Medicine	Past	Accepting new patients
Reliant Medical Group, Inc		Past	Accepting new patients

Interoperability endpoints

Direct secure messaging: lmietkiewicz23311@umassmemorial.direct-ci.com

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.

Reliant Medical Group, Inc
- Physical Therapist
- Worcester, MA
- NPI 1295827962
NPD (past)
Reliant Medical Group, Inc
- Family Medicine Physician
- Worcester, MA
- NPI 1720017528
Internal Medicine
NPD (past)

NPI Registry JSON

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627948800000",
    "number": "1285609479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348",
            "telephone_number": "800-225-8885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 PLANTATION ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052323",
            "telephone_number": "508-334-1448",
            "fax_number": "508-334-1443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIETKIEWICZ",
        "first_name": "LESTER",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "49809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ONE HEALTH PLAN",
            "identifier": "042472266",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "4034906",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HEALTH PLAN",
            "identifier": "8239846",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD INDEMNITY",
            "identifier": "J02901",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "0400875",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY START",
            "identifier": "28035",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON COMMUNITY HEALTH",
            "identifier": "9900029",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM HEALTHCAR",
            "identifier": "AA1293",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE ELECT",
            "identifier": "J02901",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHILDRENS MEDICAL",
            "identifier": "28035",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHCARE VALUE MANAGEME",
            "identifier": "043058466",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD HMO BLUE",
            "identifier": "J02901",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP HEALTH CARE",
            "identifier": "784252",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "934972",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THREE RIVERS",
            "identifier": "042472266",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE HEALTHCARE",
            "identifier": "042472266",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6180493",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lmietkiewicz23311@UmassMemorial.direct-ci.com",
            "affiliation": "N",
            "address_1": "100 Worcester St",
            "address_2": "Suite 60",
            "city": "North Grafton",
            "state": "MA",
            "country_code": "US",
            "postal_code": "015361024",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "100 Worcester St",
            "address_2": "Suite 60",
            "city": "North Grafton",
            "state": "MA",
            "country_code": "US",
            "postal_code": "015361024",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.