Individual provider Active NPI

Michael A Iadevaia

  • Family Medicine Physician
  • Swansea, MA
National Provider Identifier
1376048637
Registry record updated Oct 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
287519 Issued in MA
Practice address
479 Swansea Mall Dr
Swansea, MA 02777-4119
Phone
(508) 973-1570
Fax
(508) 973-1545
NPI assigned
Mar 28, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2024

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 287519 MA Primary

Addresses

Primary practice location

479 Swansea Mall Dr
Swansea, MA 02777-4119

Mailing address

200 Mill Rd
Fairhaven, MA 02719-5252
Phone (508) 973-1570

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
I20210818001736 MA Practitioner - Family Practice 1153679451 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Tufts University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southcoast Physicians Group IncGroup PAC ID 0749171957, 875 clinicians

Practice addresses (Care Compare)

479 Swansea Mall Dr
Swansea, MA 02777-4119
Phone (508) 973-1570

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
287519MAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southcoast Physicians Group, Inc. CurrentSince Aug 1, 2021 Accepting new patients
Southcoast Physicians Group, Inc. Family Medicine CurrentSince Aug 1, 2021 Accepting new patients

Locations

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

479 Swansea Mall Dr
Swansea, MA 02777
Phone (508) 672-5300

Interoperability endpoints

  • Direct secure messaging: miadevaia59126@direct.southcoast.org

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 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": "1522195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729209600000",
    "number": "1376048637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MILL RD",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "027195252",
            "telephone_number": "508-973-1570",
            "fax_number": "508-973-1545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "479 SWANSEA MALL DR",
            "city": "SWANSEA",
            "state": "MA",
            "postal_code": "027774119",
            "telephone_number": "508-973-1570",
            "fax_number": "508-973-1545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IADEVAIA",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-28",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "287519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Swansea, MA

Sources for this page

Verify at the official NPI Registry.