NPIMap

Organization Active NPI

Advanced Wound Recovery - Boston, LLC

Doing business as Advanced Wound Recovery of Boston

  • Internal Medicine Physician
  • Waltham, MA
National Provider Identifier
1316958150
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ADVANCED WOUND RECOVERY - BOSTON, LLC
Doing business as
Advanced Wound Recovery of Boston
Practice address
9 Hope Ave
Suite 130
Waltham, MA 02453-2741
Phone
(781) 891-0030
Fax
(781) 891-7030
NPI assigned
Aug 10, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ikram A Farooqi, MDNPI 1285685834
Title
Medical Director/Partner
Phone
(781) 891-0030

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

9 Hope Ave
Suite 130
Waltham, MA 02453-2741

Mailing address

9 Hope Ave
Suite 130
Waltham, MA 02453-2741
Phone (781) 891-0030

Other identifiers 4

IdentifierTypeStateIssuer
3600202OtherMAAETNA
M18836OtherMABCBS
696163OtherMATUFTS
9736221MedicaidMA

Other names 1

  • Advanced Wound Recovery of Boston Doing business as

National Provider Directory

National Provider Directory

Locations

9 Hope Ave
Fl 9
Waltham, MA 02453
Phone (781) 647-6800

9 Hope Ave
Ste 130
Waltham, MA 02453
Phone (781) 891-0030

65 Walnut St
Ste 440
Wellesley Hills, MA 02481
Phone (781) 235-7700

18 Frances St
Woburn, MA 01801
Phone (781) 933-8175

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316958150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 HOPE AVE",
            "address_2": "SUITE 130",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024532741",
            "telephone_number": "781-891-0030",
            "fax_number": "781-891-7030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 HOPE AVE",
            "address_2": "SUITE 130",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024532741",
            "telephone_number": "781-891-0030",
            "fax_number": "781-891-7030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED WOUND RECOVERY - BOSTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FAROOQI",
        "authorized_official_first_name": "IKRAM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/PARTNER",
        "authorized_official_telephone_number": "781-891-0030",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "3600202",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "M18836",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "696163",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9736221",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Wound Recovery of Boston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waltham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.