NPIMap

Organization Active NPI

Marblehead Pediatrics

  • Pediatrics Physician
  • Marblehead, MA
National Provider Identifier
1386794584
Registry record updated Aug 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MARBLEHEAD PEDIATRICS
Practice address
70 Atlantic Ave
Marblehead, MA 01945-3042
Phone
(781) 631-7800
Fax
(781) 631-4319
NPI assigned
Jan 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2022

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

Authorized official

Name
Lisa A Gast, D.O.NPI 1093791378
Title
President
Phone
(781) 631-7800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

70 Atlantic Ave
Marblehead, MA 01945-3042

Mailing address

70 Atlantic Ave
Marblehead, MA 01945-3042
Phone (781) 631-7800

Other identifiers 2

IdentifierTypeStateIssuer
9718338MedicaidMA
110068239MedicaidMA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D0073219Marblehead Pediatrics70 Atlantic Avenue, Marblehead, MA 01945Certificate of waiverJan 26, 2028

National Provider Directory

National Provider Directory

Locations

70 Atlantic Ave
Marblehead, MA 01945
Phone (781) 307-0098

Interoperability endpoints

  • Direct secure messaging: shen.daniel.mhped@direct.partners.masshiway.net
  • Direct secure messaging: bowers.amanda.mhped@direct.partners.masshiway.net
  • Direct secure messaging: ehrenberg.rebecca.mhped@direct.partners.masshiway.net
  • Direct secure messaging: gast.lisa.mhped@direct.partners.masshiway.net
  • Direct secure messaging: o'connor.sarah.mhped@direct.partners.masshiway.net

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661904000000",
    "number": "1386794584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 ATLANTIC AVE",
            "city": "MARBLEHEAD",
            "state": "MA",
            "postal_code": "019453042",
            "telephone_number": "781-631-7800",
            "fax_number": "781-631-4319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 ATLANTIC AVE",
            "city": "MARBLEHEAD",
            "state": "MA",
            "postal_code": "019453042",
            "telephone_number": "781-631-7800",
            "fax_number": "781-631-4319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARBLEHEAD PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A",
        "authorized_official_last_name": "GAST",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-631-7800",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9718338",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110068239",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marblehead, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.