Individual provider Active NPI

Richard C Tibbetts, M.D.

  • Internal Medicine Physician
  • Worcester, MA
National Provider Identifier
1295096501
Registry record updated Jun 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
251816 Issued in MA
Practice address
55 Lake Ave N
Worcester, MA 01655-0002
Phone
(508) 334-1000
NPI assigned
Jun 4, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 251816 MA Primary

Addresses

Primary practice location

55 Lake Ave N
Worcester, MA 01655-0002

Mailing address

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150818004186 MA Practitioner - HospitalistPractitioner - Internal Medicine 7214168863 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
University of Massachusetts Medical School, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coastal Medical AssociatesGroup PAC ID 7113029257, 443 clinicians

Practice addresses (Care Compare)

55 Fogg Rd
Weymouth, MA 02190-2432
Phone (781) 792-4136

Hospital & facility affiliations

  • South Shore Hospital Hospital, South Weymouth, MA, CCN 220100

Merit-based Incentive Payment System (MIPS)

Final score
86.65 of 100Reported as group
Quality
88.12
Promoting interoperability
71
Improvement activities
40
Cost
77.69

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
251816MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Medical Associates CurrentSince Jun 1, 2015 Accepting new patients
South Shore Hospital Inc. Past Accepting new patients

Locations

141 Longwater Dr
Ste 201
Norwell, MA 02061
Phone (781) 261-7820

55 Fogg Rd
Weymouth, MA 02190
Phone (781) 340-4293

55 Fogg Rd
#81
Weymouth, MA 02190

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 1

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": "1338768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338768000000",
    "number": "1295096501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 LAKE AVE N",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016550002",
            "telephone_number": "508-334-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAKE AVE N",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016550002",
            "telephone_number": "508-334-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBBETTS",
        "first_name": "RICHARD",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-04",
        "last_updated": "2012-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "251816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.