Individual provider Active NPI

Shahe Fereshetian, M.D.

  • Plastic Surgery Physician
  • West Roxbury, MA
National Provider Identifier
1447244173
Registry record updated May 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
71442 Issued in MA
Practice address
1400 VFW Pkwy
West Roxbury, MA 02132-4927
Phone
(617) 323-7700
NPI assigned
Sep 8, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 71442 MA Primary

Addresses

Primary practice location

1400 VFW Pkwy
West Roxbury, MA 02132-4927

Mailing address

90 Libbey Industrial Pkwy
Weymouth, MA 02189-3129
Phone (781) 624-8000

Other practice location 1

90 Libbey Industrial Pkwy
Weymouth, MA 02189-3129
Phone (781) 624-8000

Other identifiers 1

IdentifierTypeStateIssuer
3050769MedicaidMA

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
I20060202000516 MA Practitioner - Plastic and Reconstructive Surgery 3072527613 Reassigns benefits to 1 organization
Practice locations: Cambridge, MA

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coastal Medical AssociatesGroup PAC ID 7113029257, 443 clinicians

Practice addresses (Care Compare)

55 Fogg Rd
Weymouth, MA 02190-2432
Phone (781) 792-4136

90 Libbey Pkwy
Suite 100
Weymouth, MA 02189-3130
Phone (781) 624-4950

Hospital & facility affiliations

  • Croi Health Home health agency, Norwell, MA, CCN 227241
  • South Shore Hospital Hospital, South Weymouth, MA, CCN 220100

Merit-based Incentive Payment System (MIPS)

Final score
86.65 of 100Reported as group
Quality
88.12
Promoting interoperability
71
Improvement activities
40
Cost
77.69

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue196
Removal of skin lesions22

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Medical Associates CurrentSince Oct 1, 2014 Accepting new patients

Locations

55 Fogg Rd
Weymouth, MA 02190
Phone (781) 340-4293

90 Libbey Park
Weymouth, MA 02189
Phone (781) 331-0537

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1447244173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 LIBBEY INDUSTRIAL PKWY",
            "city": "WEYMOUTH",
            "state": "MA",
            "postal_code": "021893129",
            "telephone_number": "781-624-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 VFW PKWY",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021324927",
            "telephone_number": "617-323-7700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "90 Libbey Industrial Pkwy",
            "address_purpose": "LOCATION",
            "city": "Weymouth",
            "state": "MA",
            "postal_code": "021893129",
            "country_code": "US",
            "telephone_number": "781-624-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERESHETIAN",
        "first_name": "SHAHE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-08",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MA",
            "license": "71442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3050769",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Roxbury, MA

Sources for this page

Verify at the official NPI Registry.