Active NPI
Cameron M Govonlu, MD
- Interventional Pain Medicine Physician
- Raynham, MA
National Provider Identifier
1407877434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Pain Medicine Physician
- License
- 47135
- Practice address
- 1244 Broadway
Raynham, MA 02767-1973 - Phone
- (508) 824-0035
- Fax
- (508) 823-6127
- NPI assigned
- Jul 23, 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 47135 | MA | |
| Interventional Pain Medicine Physician | 208VP0014X | 47135 | MA | Primary |
Addresses
Primary practice location
1244 Broadway
Raynham, MA 02767-1973
Mailing address
1244 Broadway
Raynham, MA 02767-1973
Phone (508) 824-0035
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0176753 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2021 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 47135 | MA | MD | Interventional Pain Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358294400000",
"number": "1407877434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1244 BROADWAY",
"city": "RAYNHAM",
"state": "MA",
"postal_code": "027671973",
"telephone_number": "508-824-0035",
"fax_number": "508-823-6127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1244 BROADWAY",
"city": "RAYNHAM",
"state": "MA",
"postal_code": "027671973",
"telephone_number": "508-824-0035",
"fax_number": "508-823-6127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOVONLU",
"first_name": "CAMERON",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-23",
"last_updated": "2013-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "MA",
"license": "47135",
"primary": false
},
{
"code": "208VP0014X",
"taxonomy_group": "",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": "MA",
"license": "47135",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0176753",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raynham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.