NPIMap

Individual provider Active NPI

David L Barrasso, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Medford, MA
National Provider Identifier
1467433748
Registry record updated Nov 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
38593 Issued in MA
Practice address
170 Governors Ave
Medford, MA 02155-1643
Phone
(781) 937-9960
Fax
(781) 431-1689
NPI assigned
Nov 14, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 17, 2009

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 38593 MA
Cardiovascular Disease Physician 207RC0000X 38593 MA
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 38593 MA Primary

Addresses

Primary practice location

170 Governors Ave
Medford, MA 02155-1643

Mailing address

170 Governors Ave
Medford, MA 02155-1643
Phone (781) 937-9960

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050926001035 MA Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology)Practitioner - Geriatric Medicine 8921032228 Practice locations: Wilmington, MA; Wakefield, MA; Reading, MA; Peabody, MA; North Reading, MA; Newton, MA; Nahant, MA; Melrose, MA…

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
38593MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
199 Andover Street Operating Company, LLC Past Accepting new patients
Belmont Manor Nursing Home Inc Past Accepting new patients
Wellesley Healthcare Solutions LLC PastSince Jun 1, 2012 Accepting new patients
Bear Mt Reading LLC Past Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Jesmond Skilled Nursing & Rehabilitation CenterNahant, MA, CCN 225471 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 2012
Jun 1, 2012
Compassionate Care Hospice of Massachusetts LLCWoburn, MA, CCN 221582 Hospice W-2 Managing Employee Dec 9, 2016

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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": "1131926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258416000000",
    "number": "1467433748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 GOVERNORS AVE",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021551643",
            "telephone_number": "781-937-9960",
            "fax_number": "781-431-1689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 GOVERNORS AVE",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021551643",
            "telephone_number": "781-937-9960",
            "fax_number": "781-431-1689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARRASSO",
        "first_name": "DAVID",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-14",
        "last_updated": "2009-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "38593",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MA",
            "license": "38593",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MA",
            "license": "38593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, MA

Sources for this page

Verify at the official NPI Registry.