NPIMap

Organization Active NPI

Integrated Wound Care Massachusetts PLLC

  • General Practice Physician
  • Wilmington, MA
National Provider Identifier
1437629458
Registry record updated Mar 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
INTEGRATED WOUND CARE MASSACHUSETTS PLLC
Practice address
750 Woburn St
Wilmington, MA 01887-3480
Phone
(732) 451-4318
NPI assigned
Dec 3, 2018
Last updated
Mar 13, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2019

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

Authorized official

Name
Dr. Diane Lusas, MDNPI 1730475658
Title
Memebr
Phone
(732) 451-4318

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

750 Woburn St
Wilmington, MA 01887-3480

Mailing address

492C Cedar LN Ste 514
Teaneck, NJ 07666-1713

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190201000118 MA Part B Supplier - Clinic/Group Practice 5991042756 Receives reassigned benefits from 30 practitioners
Practice locations: Boston, MA

National Provider Directory

National Provider Directory

Locations

105 Linden St W
Stillwater, MN 55082
Phone (651) 439-5004

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1543795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552435200000",
    "number": "1437629458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "492C CEDAR LN STE 514",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076661713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 WOBURN ST",
            "city": "WILMINGTON",
            "state": "MA",
            "postal_code": "018873480",
            "telephone_number": "732-451-4318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED WOUND CARE MASSACHUSETTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-03",
        "last_updated": "2019-03-13",
        "status": "A",
        "authorized_official_last_name": "LUSAS",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "MEMEBR",
        "authorized_official_telephone_number": "732-451-4318",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.