NPIMap

Individual provider Active NPI

Indira Mahidhara, MD

  • Family Medicine Physician
  • Lawrence, MA
National Provider Identifier
1477504835
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
226631 Issued in MA
Practice address
73D Winthrop Ave
Plaza 114
Lawrence, MA 01843-3716
Phone
(978) 686-3017
Fax
(978) 685-4280
NPI assigned
May 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 226631 MA Primary

Addresses

Primary practice location

73D Winthrop Ave
Plaza 114
Lawrence, MA 01843-3716

Mailing address

73D Winthrop Ave
Plaza 114
Lawrence, MA 01843-3716
Phone (978) 686-3017

Other identifiers 4

IdentifierTypeStateIssuer
96223OtherFALLON COMM HEALTH PLAN
J27866OtherBLUE CARE ELECT
4147095OtherMVP HEALTH CARE
AA49793OtherHARVARD PILGRAM HLTH CARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Reliant Medical Group, Inc Family Medicine PastSince Oct 15, 2007 Accepting new patients
Reliant Medical Group, Inc Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477504835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73D WINTHROP AVE",
            "address_2": "PLAZA 114",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018433716",
            "telephone_number": "978-686-3017",
            "fax_number": "978-685-4280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73D WINTHROP AVE",
            "address_2": "PLAZA 114",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018433716",
            "telephone_number": "978-686-3017",
            "fax_number": "978-685-4280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHIDHARA",
        "first_name": "INDIRA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "226631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON COMM HEALTH PLAN",
            "identifier": "96223",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE ELECT",
            "identifier": "J27866",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP HEALTH CARE",
            "identifier": "4147095",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRAM HLTH CARE",
            "identifier": "AA49793",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrence, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.