Individual provider Active NPI

Mairead Rynn Wilson, M.D.

  • Pediatrics Physician
  • S Weymouth, MA
National Provider Identifier
1417116054
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
246120 Issued in MA
Practice address
55 Fogg Rd
S Weymouth, MA 02190-2432
Phone
(781) 624-8000
NPI assigned
Jun 9, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 246120 MA Primary

Addresses

Primary practice location

55 Fogg Rd
S Weymouth, MA 02190-2432

Mailing address

300 Longwood Ave
Boston, MA 02115-5724
Phone (617) 355-6000

Other practice location 1

680 Centre St
Brockton, MA 02302-3308
Phone (508) 941-7580

Other practice location 2

27 Park St
Hyannis, MA 02601-5230
Phone (508) 771-1800

Other practice location 3

300 Longwood Ave
Boston, MA 02115-5724
Phone (617) 355-6000

Other identifiers 10

IdentifierTypeStateIssuer
04-2297845OtherTRICARE
AA436677OtherMAHARVARD PILGRIM
3975418OtherCIGNA
1417116054OtherMANEIGHBORHOOD HEALTH PLAN
04-2297845OtherUNITED HEALTH CARE
04-2297845OtherMULTI-PLAN
9984652OtherAETNA
J48728OtherMABCBSMA
1417116054OtherFALLON COMMUNITY HEALTH PLAN
04-2297845OtherHCVM

Other names 1

  • Dr. Mairead Rynn Donahue Former name

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
I20120406000032 MA Practitioner - Pediatric Medicine 0749441418 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Signature Healthcare Medical Group Inc Pediatrics CurrentSince Oct 1, 2025 Accepting new patients
Brockton Hospital, Inc. Past Accepting new patients
Cape Cod Hospital Inc Past Accepting new patients

Locations

300 Longwood Ave
Boston, MA 02115
Phone (617) 355-4956

680 Centre St
Brockton, MA 02302
Phone (508) 941-7400

Organizations & group practices 5

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": "1212969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760400000000",
    "number": "1417116054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155724",
            "telephone_number": "617-355-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FOGG RD",
            "city": "S WEYMOUTH",
            "state": "MA",
            "postal_code": "021902432",
            "telephone_number": "781-624-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "680 Centre St",
            "address_purpose": "LOCATION",
            "city": "Brockton",
            "state": "MA",
            "postal_code": "023023308",
            "country_code": "US",
            "telephone_number": "508-941-7580",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "27 Park St",
            "address_purpose": "LOCATION",
            "city": "Hyannis",
            "state": "MA",
            "postal_code": "026015230",
            "country_code": "US",
            "telephone_number": "508-771-1800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Longwood Ave",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021155724",
            "country_code": "US",
            "telephone_number": "617-355-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MAIREAD",
        "middle_name": "RYNN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-09",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "246120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "04-2297845",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "AA436677",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "3975418",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH PLAN",
            "identifier": "1417116054",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "04-2297845",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTI-PLAN",
            "identifier": "04-2297845",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9984652",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMA",
            "identifier": "J48728",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON COMMUNITY HEALTH PLAN",
            "identifier": "1417116054",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HCVM",
            "identifier": "04-2297845",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAIREAD",
            "last_name": "DONAHUE",
            "middle_name": "RYNN",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in S Weymouth, MA

Sources for this page

Verify at the official NPI Registry.