Individual provider Active NPI

Lewis Richard Gergoudis, MD

  • Family Medicine Physician
  • Jamaica Plain, MA
National Provider Identifier
1356839518
Registry record updated Jun 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1025841 Issued in MA
Practice address
1153 Centre St
Jamaica Plain, MA 02130-3446
Phone
(617) 983-7300
NPI assigned
Apr 24, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1025841 MA Primary

Addresses

Primary practice location

1153 Centre St
Jamaica Plain, MA 02130-3446

Mailing address

399 Revolution Dr
Somerville, MA 02145-1484

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20211116001522 NC Practitioner - Family Practice 5799032611 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Virginia Commonwealth University, School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Carolina UniversityGroup PAC ID 0244143246, 499 clinicians
Proactive Therapy of North Carolina IncGroup PAC ID 6305753120, shared by 5 NPIs, 540 clinicians
Brigham and Womens Physicians Organization IncGroup PAC ID 3870405988, shared by 5 NPIs, 2,931 clinicians

Practice addresses (Care Compare)

101 Heart Dr
Greenville, NC 27834-8982
Phone (252) 744-3109

2303 Wellington Dr SW
Wilson, NC 27893-8620
Phone (252) 243-6818

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

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.95 of 100Reported as apm
Quality
82.44
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue20
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2021-01397NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East Carolina University Family Medicine CurrentSince Nov 3, 2021 Accepting new patients
East Carolina University CurrentSince Nov 3, 2021 Accepting new patients

Locations

2100 Stantonsburg Rd
Greenville, NC 27834
Phone (252) 744-3229

101 Heart Dr
Greenville, NC 27834
Phone (252) 744-4611

600 Moye Blvd
Greenville, NC 27834
Phone (252) 744-1111

Interoperability endpoints

  • Direct secure messaging: lgergoudis276178@direct.ecuhealth.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.

Hospital & facility affiliations 5

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": "1524528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782259200000",
    "number": "1356839518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "399 REVOLUTION DR",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021451484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1153 CENTRE ST",
            "city": "JAMAICA PLAIN",
            "state": "MA",
            "postal_code": "021303446",
            "telephone_number": "617-983-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERGOUDIS",
        "first_name": "LEWIS",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-24",
        "last_updated": "2026-06-24",
        "certification_date": "2026-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "1025841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica Plain, MA

Sources for this page

Verify at the official NPI Registry.