Individual provider Active NPI

Ara Ketchedjian, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Boston, MA
National Provider Identifier
1467599720
Registry record updated Nov 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
219989 Issued in MA
Practice address
850 Harrison Ave
Yacc BN-C7
Boston, MA 02118-4001
Phone
(617) 414-5405
Fax
(617) 414-6031
NPI assigned
Jan 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 219989 MA Primary
Surgery Physician 208600000X 219989 MA

Addresses

Primary practice location

850 Harrison Ave
Yacc BN-C7
Boston, MA 02118-4001

Mailing address

850 Harrison Ave
Yacc BN-C7
Boston, MA 02118-4001

Other identifiers 1

IdentifierTypeStateIssuer
110075849AMedicaidMA

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
I20070814000709 MA Practitioner - Cardiac SurgeryPractitioner - Thoracic Surgery 8820189293 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiac SurgeryAlso: Thoracic Surgery
Education
State University of Ny Upstate Medical University, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians of Cape Cod HospitalGroup PAC ID 9638326671, 330 clinicians

Practice addresses (Care Compare)

27 Park St
Hyannis, MA 02601-5230
Phone (774) 552-6000

Hospital & facility affiliations

  • Cape Cod Hospital Hospital, Hyannis, MA, CCN 220012

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
219989MAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Steward Medical Group, Inc CurrentSince Jun 30, 2014 Accepting new patients
Physicians of Cape Cod Hospital CurrentSince Oct 19, 2023 Accepting new patients
Steward Medical Group, Inc CurrentSince Jun 30, 2014 Accepting new patients
Boston University Cardiac and Thoracic Surgical Foundation, Inc. Thoracic Surgery (Cardiothoracic Vascular Surgery) Past Accepting new patients
Cape Cod Hospital Inc Past Accepting new patients
Steward Medical Group Inc. Past Accepting new patients

Locations

88 Newton St
Boston, MA 02118
Phone (617) 638-7350

77 Warren St
Fl 5
Brighton, MA 02135
Phone (617) 254-3376

11 Nevins St
Ste 201
Brighton, MA 02135
Phone (617) 789-2442

27 Park St
Hyannis, MA 02601
Phone (508) 775-5011

60A Park St
Hyannis, MA 02601
Phone (508) 771-4100

100 Amesbury St
Ste 103
Lawrence, MA 01840
Phone (978) 683-0157

Organizations & group practices 6

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 1

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": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383782400000",
    "number": "1467599720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 HARRISON AVE",
            "address_2": "YACC BN-C7",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021184001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 HARRISON AVE",
            "address_2": "YACC BN-C7",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021184001",
            "telephone_number": "617-414-5405",
            "fax_number": "617-414-6031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETCHEDJIAN",
        "first_name": "ARA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2013-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MA",
            "license": "219989",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "219989",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110075849A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.