Individual provider Active NPI

Michael Scott Marshall, MD, PHD

  • Anatomic Pathology & Clinical Pathology Physician
  • Boston, MA
National Provider Identifier
1356800338
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
036163272 Issued in IL
Practice address
55 Fruit St
Boston, MA 02114-2621
Phone
(314) 409-1180
NPI assigned
Mar 18, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 1014314 MA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 036163272 IL Primary

Addresses

Primary practice location

55 Fruit St
Boston, MA 02114-2621

Mailing address

1 Nashua St Apt 3416
Boston, MA 02114-1644
Phone (314) 409-1180

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230321002014 MA Practitioner - Pathology 0345571477 Reassigns benefits to 2 organizations
I20231107003175 IL Practitioner - Pathology 0345571477 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2019
Medicare assignment
May accept Medicare assignment
Group practices
University Pathology Diagnostics SCGroup PAC ID 1052692464, 17 clinicians

Practice addresses (Care Compare)

1653 W Congress Pkwy
Chicago, IL 60612-3833
Phone (312) 942-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036163272ILMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Pathology Diagnostics SC Anatomic Pathology & Clinical Pathology CurrentSince Sep 27, 2023 Accepting new patients
Massachusetts General Physicians Organization Inc Anatomic Pathology & Clinical Pathology CurrentSince Apr 1, 2023 Accepting new patients
The General Hospital Corporation CurrentSince Apr 1, 2023 Accepting new patients

Locations

1653 W Congress Pkwy
Chicago, IL 60612
Phone (312) 942-3138

55 Fruit St
Boston, MA 02114

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

5700 Southwyck Blvd
Toledo, OH 43614

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 6

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": "1552867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1356800338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 NASHUA ST APT 3416",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021141644",
            "telephone_number": "314-409-1180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "314-409-1180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "credential": "MD, PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-18",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MA",
            "license": "1014314",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": "036163272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.