Individual provider Active NPI

Shiva Saboori, MD

  • Family Medicine Physician
  • Lawrence, MA
National Provider Identifier
1376537704
Registry record updated Oct 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
73671 Issued in MA
Practice address
150 Park St
Lawrence, MA 01841-2517
Phone
(978) 685-1770
Fax
(978) 685-4390
NPI assigned
Aug 31, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2010

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 73671 MA Primary

Addresses

Primary practice location

150 Park St
Lawrence, MA 01841-2517

Mailing address

150 Park St
Lawrence, MA 01841-2517
Phone (978) 685-1770

Other identifiers 1

IdentifierTypeStateIssuer
1303775MedicaidMA

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
I20050420000796 MA Practitioner - Family Practice 3779521760 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
73671MAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lynn Community Health, Inc. CurrentSince Jan 7, 2013 Accepting new patients
Lynn Community Health, Inc. PastSince Dec 26, 2021 Accepting new patients

Locations

280 Union St
Ste 202
Lynn, MA 01901
Phone (781) 780-4555

269 Union St
Lynn, MA 01901
Phone (781) 581-9832

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.

NPI Registry JSON

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287619200000",
    "number": "1376537704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 PARK ST",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018412517",
            "telephone_number": "978-685-1770",
            "fax_number": "978-685-4390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 PARK ST",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018412517",
            "telephone_number": "978-685-1770",
            "fax_number": "978-685-4390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SABOORI",
        "first_name": "SHIVA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-31",
        "last_updated": "2010-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "73671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1303775",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrence, MA

Sources for this page

Verify at the official NPI Registry.