Active NPI
High Performance Sports Medicine, PC
- Orthopaedic Surgery Physician
- Beverly, MA
National Provider Identifier
1508859463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DC0756 | Other | RAILROAD MEDICARE | |
| 9723820 | Medicaid | MA | |
| M18148 | Other | MA | BLUE CROSS BLUE SHIELD |
| 171031 | Other | HARVARD PILGRIM | |
| 693840 | Other | TUFTS HEALTH PLAN | |
| 2998140 | Other | AETNA | |
| M21205 | Other | MEDICARE PTAN | |
| 0028303 | Other | NEIGHBORHOOD HEALTH PLAN |
National Provider Directory
National Provider DirectoryLocations
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.
-
- Orthopaedic Surgery Physician
- Norwood, MA
- NPI 1710945647
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.