Individual provider Active NPI

Jordan Chase Wengrod, M.D., PH.D.

  • Hematology & Oncology Physician
  • Boston, MA
National Provider Identifier
1407237613
Registry record updated Oct 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
272966 Issued in MA
Practice address
450 Brookline Ave
Boston, MA 02215-5418
Phone
(617) 632-3000
NPI assigned
Jun 12, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 272966 MA Primary
Internal Medicine Physician 207R00000X 272966 MA

Addresses

Primary practice location

450 Brookline Ave
Boston, MA 02215-5418

Mailing address

75 Francis St
Boston, MA 02115-6110
Phone (617) 732-5500

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
I20191204002246 MA Practitioner - Internal Medicine 4789991332 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
272966MAMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Massachusetts General Physicians Organization Inc Internal Medicine CurrentSince Oct 9, 2019 Accepting new patients

Locations

75 Francis St
Boston, MA 02115

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

Organizations & group practices 1

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": "1434067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572393600000",
    "number": "1407237613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 FRANCIS ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156110",
            "telephone_number": "617-732-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 BROOKLINE AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022155418",
            "telephone_number": "617-632-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENGROD",
        "first_name": "JORDAN",
        "middle_name": "CHASE",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-12",
        "last_updated": "2019-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MA",
            "license": "272966",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "272966",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.