Individual provider Active NPI

Meaghan C. Doherty, M.D.

  • Pediatric Cardiology Physician
  • Worcester, MA
National Provider Identifier
1417277237
Registry record updated Nov 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
268174 Issued in MA
Practice address
55 Lake Ave N
Worcester, MA 01655-0002
Phone
(774) 441-7765
Fax
(774) 441-8054
NPI assigned
Jun 3, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 21, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X LP01977 RI
Pediatric Cardiology Physician 2080P0202X 268174 MA Primary

Addresses

Primary practice location

55 Lake Ave N
Worcester, MA 01655-0002

Mailing address

PO Box 415348
Boston, MA 02241-5348
Phone (800) 225-8885

Other identifiers 1

IdentifierTypeStateIssuer
110120101AMedicaidMA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mdoherty331871@UmassMemorial.direct-ci.com
FHIR URL https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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
I20170315000325 MA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Pediatric Medicine 7618997875 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Pediatric Medicine
Education
University of Massachusetts Medical School, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Umass Memorial Medical Group IncGroup PAC ID 4284539891, 2,494 clinicians

Practice addresses (Care Compare)

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
82.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LP01977RIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Umass Memorial Medical Group Inc Pediatrics CurrentSince Jul 1, 2020 Accepting new patients
Umass Memorial Medical Group, Inc. CurrentSince Jul 1, 2020 Accepting new patients

Locations

119 Belmont St
Worcester, MA 01605
Phone (508) 334-6345

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

593 Eddy St
Providence, RI 02903

Interoperability endpoints

  • Direct secure messaging: mdoherty331871@umassmemorial.direct-ci.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1275523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605916800000",
    "number": "1417277237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348",
            "telephone_number": "800-225-8885",
            "fax_number": "508-334-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAKE AVE N",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016550002",
            "telephone_number": "774-441-7765",
            "fax_number": "774-441-8054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOHERTY",
        "first_name": "MEAGHAN",
        "middle_name": "C.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-03",
        "last_updated": "2020-11-21",
        "certification_date": "2020-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "RI",
            "license": "LP01977",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "MA",
            "license": "268174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110120101A",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdoherty331871@UmassMemorial.direct-ci.com",
            "affiliation": "N",
            "address_1": "55 Lake Ave N",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016550002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "55 Lake Ave N",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016550002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.