Individual provider Active NPI

Jonathan Seth Friedstat, MD

  • Plastic and Reconstructive Surgery Physician
  • Boston, MA
National Provider Identifier
1316056245
Registry record updated Apr 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
Q2768 Issued in TX
Practice address
55 Fruit Street
GRB 1303, Frasier Outpatient Burn Center
Boston, MA 02114
Phone
(617) 726-3712
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X ML20008564 WA
Surgical Critical Care Physician 2086S0102X 246710 MA
Plastic and Reconstructive Surgery Physician 2086S0122X Q2768 TX Primary

Addresses

Primary practice location

55 Fruit Street
GRB 1303, Frasier Outpatient Burn Center
Boston, MA 02114

Mailing address

55 Fruit St
Boston, MA 02114-2696
Phone (617) 726-3712

Other identifiers 1

IdentifierTypeStateIssuer
347245801 (MDACC)MedicaidTX

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 IDStateProvider typePAC IDDetails
I20160617001528 MA Practitioner - General SurgeryPractitioner - Plastic and Reconstructive SurgeryPractitioner - Critical Care (Intensivists) 5597923896 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Critical Care (Intensivists), Plastic and Reconstructive Surgery
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

75 Francis St
Boston, MA 02115-6110
Phone (617) 732-5500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ML20008564WAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
General Hospital Corp Current Accepting new patients
The Shriners' Hospital for Children Surgery CurrentSince Mar 18, 2020 Accepting new patients
The General Hospital Corporation CurrentSince Jul 1, 2016 Accepting new patients
Massachusetts General Physicians Organization Inc Surgery CurrentSince Jul 1, 2016 Accepting new patients
The Shriners' Hospital for Children CurrentSince Mar 18, 2020 Accepting new patients
The Shriners' Hospital for Children Current Accepting new patients

Locations

55 Fruit St
#1302
Boston, MA 02114
Phone (617) 726-3184

55 Fruit St
#1303
Boston, MA 02114
Phone (617) 726-3354

55 Fruit St
Boston, MA 02114

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

516 Carew St
Springfield, MA 01104
Phone (413) 787-2000

Interoperability endpoints

  • Direct secure messaging: friedstat.jonathan.mgh@direct.partners.masshiway.net

Organizations & group practices 6

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 2

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523232000000",
    "number": "1316056245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142696",
            "telephone_number": "617-726-3712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT STREET",
            "address_2": "GRB 1303, FRASIER OUTPATIENT BURN CENTER",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02114",
            "telephone_number": "617-726-3712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRIEDSTAT",
        "first_name": "JONATHAN",
        "middle_name": "SETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2018-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "ML20008564",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "MA",
            "license": "246710",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "TX",
            "license": "Q2768",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "347245801 (MDACC)",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.