Active NPI
Herbert S Plovnick, M.D.
- Internal Medicine Physician
- Medford, MA
National Provider Identifier
1396780904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 38333
- Practice address
- 26 City Hall Mall
Internal Medicine
Medford, MA 02155-4754 - Phone
- (781) 306-5345
- Fax
- (781) 306-5015
- NPI assigned
- Jun 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 38333 | MA | Primary |
| Endocrinology, Diabetes & Metabolism Physician | 207RE0101X | 38333 | MA |
Addresses
Primary practice location
26 City Hall Mall
Internal Medicine
Medford, MA 02155-4754
Mailing address
147 Milk St
Provider Enrollment - 9TH Floor
Boston, MA 02109-4806
Phone (617) 559-8374
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| M09787 | Other | MA | BLUE CROSS |
| 705817 | Other | MA | TUFTS |
| 0119873 | Medicaid | MA | |
| 0015311 | Other | MA | NEIGHBRHOOD HEALTH |
| V534 | Other | MA | HARVARD PILGRIM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308096000000",
"number": "1396780904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "147 MILK ST",
"address_2": "PROVIDER ENROLLMENT - 9TH FLOOR",
"city": "BOSTON",
"state": "MA",
"postal_code": "021094806",
"telephone_number": "617-559-8374"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 CITY HALL MALL",
"address_2": "INTERNAL MEDICINE",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021554754",
"telephone_number": "781-306-5345",
"fax_number": "781-306-5015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PLOVNICK",
"first_name": "HERBERT",
"middle_name": "S",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-18",
"last_updated": "2011-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "38333",
"primary": true
},
{
"code": "207RE0101X",
"taxonomy_group": "",
"desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
"state": "MA",
"license": "38333",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "M09787",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "705817",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0119873",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEIGHBRHOOD HEALTH",
"identifier": "0015311",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "V534",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.