NPIMap

Individual provider Active NPI

Jonathan S. Forman, MD

  • Internal Medicine Physician
  • Dedham, MA
National Provider Identifier
1386641785
Registry record updated Jan 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
45833 Issued in MA
Practice address
1 Lyons St
Dedham, MA 02026-5599
Phone
(781) 493-3570
Fax
(781) 326-0221
NPI assigned
Jun 30, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 45833 MA Primary

Addresses

Primary practice location

1 Lyons St
Dedham, MA 02026-5599

Mailing address

1 Lyons St
Dedham, MA 02026-5599
Phone (781) 493-3570

Other identifiers 18

IdentifierTypeStateIssuer
768324OtherTUFTS COMMONWEALTH PPO
J01138OtherHMO BLUE/BLUE CHOICE
0019013OtherNEIGHBOORHOOD HEALTH PLAN
6908353OtherCIGNA HEALTH CARE
69648OtherHARVARD/PILGRIM
768324OtherTUFTS TOTAL HEALTH PLAN
27398OtherCHILDREN'S MEDICAL SEC.
3093174OtherMASS HEALTH (DIV OF MED)
6908353OtherHEALTHSOURCE MASSACHUSETT
768324OtherTUFTS
768324OtherTUFTS BENEFIT ADMIN.
J01138OtherBS- BLUE CARE ELECT
69648OtherHARVARD PILGRIM PPO
69648OtherHARVARD PILGRIM POS
J01138OtherBLUE SHIELD-INDEMNITY
69648OtherFIRST SENIORITY
J01138OtherBCBSMA
110199968OtherRAILROAD/MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jformanmd15559@direct.atrius.masshiway.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050323000200 MA Practitioner - Internal MedicinePractitioner - Nephrology 9537115514 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
Boston University School of Medicine, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Atrius Health IncGroup PAC ID 4789588641, 1,214 clinicians

Practice addresses (Care Compare)

1 Lyons St
Dedham, MA 02026-5599
Phone (781) 329-1400

100 2ND Ave
Needham, MA 02494-2809
Phone (781) 726-4800

1250 Hancock St
Quincy, MA 02169-4339
Phone (617) 740-0600

133 Brookline Ave
Boston, MA 02215-3904
Phone (617) 421-1000

2 Technology Park Dr
Suite a
Bourne, MA 02532-8341
Phone (508) 743-9543

20 Wall St
Burlington, MA 01803-4758
Phone (781) 221-2500

21 Bristol Dr
South Easton, MA 02375-1199
Phone (774) 302-5700

291 Independence Dr
Chestnut Hill, MA 02467-3628
Phone (617) 325-2800

36 Shops at 5 Way
Plymouth, MA 02360-2677
Phone (774) 608-3700

420 Libbey Industrial Pkwy
Weymouth, MA 02189-3134
Phone (781) 331-9880

90 Libbey Industrial Pkwy
Suite 201
Weymouth, MA 02189-3157
Phone (781) 682-0606

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
45833MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Atrius Health, Inc. Internal Medicine Current Accepting new patients
Atrius Health, Inc. Internal Medicine CurrentSince May 1, 2015 Accepting new patients
Atrius Health, Inc. Internal Medicine CurrentSince May 1, 2015 Accepting new patients

Locations

147 Milk St
Fl 9
Boston, MA 02109
Phone (617) 559-8051

133 Brookline Ave
Boston, MA 02215
Phone (617) 421-1000

1 Lyons St
Dedham, MA 02026
Phone (781) 278-5511

Interoperability endpoints

  • Direct secure messaging: jformanmd15559@direct.atrius.masshiway.net
  • Direct secure messaging: jonathan.forman.1@24697.direct.athenahealth.com

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 10

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": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611792000000",
    "number": "1386641785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LYONS ST",
            "city": "DEDHAM",
            "state": "MA",
            "postal_code": "020265599",
            "telephone_number": "781-493-3570",
            "fax_number": "781-326-0221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 LYONS ST",
            "city": "DEDHAM",
            "state": "MA",
            "postal_code": "020265599",
            "telephone_number": "781-493-3570",
            "fax_number": "781-326-0221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "JONATHAN",
        "middle_name": "S.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-30",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "45833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS COMMONWEALTH PPO",
            "identifier": "768324",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMO BLUE/BLUE CHOICE",
            "identifier": "J01138",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBOORHOOD HEALTH PLAN",
            "identifier": "0019013",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HEALTH CARE",
            "identifier": "6908353",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD/PILGRIM",
            "identifier": "69648",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS TOTAL HEALTH PLAN",
            "identifier": "768324",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHILDREN'S MEDICAL SEC.",
            "identifier": "27398",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASS HEALTH (DIV OF MED)",
            "identifier": "3093174",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHSOURCE MASSACHUSETT",
            "identifier": "6908353",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "768324",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS BENEFIT ADMIN.",
            "identifier": "768324",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS- BLUE CARE ELECT",
            "identifier": "J01138",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM PPO",
            "identifier": "69648",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM POS",
            "identifier": "69648",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD-INDEMNITY",
            "identifier": "J01138",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST SENIORITY",
            "identifier": "69648",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMA",
            "identifier": "J01138",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD/MEDICARE",
            "identifier": "110199968",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jformanmd15559@direct.atrius.masshiway.net",
            "affiliation": "N",
            "address_1": "1 Lyons St",
            "city": "Dedham",
            "state": "MA",
            "country_code": "US",
            "postal_code": "020265599",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dedham, MA

Sources for this page

Verify at the official NPI Registry.