Organization Active NPI

High Performance Sports Medicine, PC

  • Orthopaedic Surgery Physician
  • Beverly, MA
National Provider Identifier
1508859463
Registry record updated Nov 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
HIGH PERFORMANCE SPORTS MEDICINE, PC
Practice address
900 Cummings Ctr
Suite 130-U
Beverly, MA 01915-6198
Phone
(978) 921-7590
Fax
(978) 921-7597
NPI assigned
Aug 25, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2014

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

Authorized official

Name
Mark P. Gilligan, MD
Title
President
Phone
(978) 921-7590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

900 Cummings Ctr
Suite 130-U
Beverly, MA 01915-6198

Mailing address

900 Cummings Ctr
Suite 130-U
Beverly, MA 01915-6198
Phone (978) 921-7590

Other identifiers 8

IdentifierTypeStateIssuer
DC0756OtherRAILROAD MEDICARE
9723820MedicaidMA
M18148OtherMABLUE CROSS BLUE SHIELD
171031OtherHARVARD PILGRIM
693840OtherTUFTS HEALTH PLAN
2998140OtherAETNA
M21205OtherMEDICARE PTAN
0028303OtherNEIGHBORHOOD HEALTH PLAN

National Provider Directory

National Provider Directory

Locations

900 Cummings Ctr
Ste 130U
Beverly, MA 01915
Phone (978) 969-3624

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415318400000",
    "number": "1508859463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 CUMMINGS CTR",
            "address_2": "SUITE 130-U",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156198",
            "telephone_number": "978-921-7590",
            "fax_number": "978-921-7597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 CUMMINGS CTR",
            "address_2": "SUITE 130-U",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156198",
            "telephone_number": "978-921-7590",
            "fax_number": "978-921-7597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGH PERFORMANCE SPORTS MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-25",
        "last_updated": "2014-11-07",
        "status": "A",
        "authorized_official_last_name": "GILLIGAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-921-7590",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC0756",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9723820",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "M18148",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "171031",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "693840",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2998140",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "M21205",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH PLAN",
            "identifier": "0028303",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2014; 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.