Individual provider Active NPI

Edress Othman, MD

  • Hematology & Oncology Physician
  • Fairhaven, MA
National Provider Identifier
1508916792
Registry record updated Apr 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
254703 Issued in MA
Practice address
206 Mill Rd
Fairhaven, MA 02719-5208
Phone
(508) 973-3000
Fax
(508) 973-3119
NPI assigned
Jan 11, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 254703 MA Primary

Addresses

Primary practice location

206 Mill Rd
Fairhaven, MA 02719-5208

Mailing address

200 Mill Rd
Suite 180
Fairhaven, MA 02719-5252
Phone (508) 973-2000

Other identifiers 1

IdentifierTypeStateIssuer
1508916792MedicaidMA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address eothman12963@direct.southcoast.org

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
I20130917000122 MA Practitioner - Hematology/Oncology 4082690227 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southcoast Physicians Group IncGroup PAC ID 0749171957, 875 clinicians

Practice addresses (Care Compare)

534 Prospect St
Fall River, MA 02720-5281
Phone (508) 973-7766

Hospital & facility affiliations

  • Southcoast Visiting Nurse Association Inc Home health agency, Fairhaven, MA, CCN 227101
  • Southcoast Hospitals Group Hospital, Fall River, MA, CCN 220074

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southcoast Physicians Group, Inc. CurrentSince Jul 4, 2013 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Jul 4, 2013 Accepting new patients
Southcoast Physicians Group, Inc. Current Accepting new patients
Carle Health Care Incorporated Past Accepting new patients

Locations

200 Mill Rd
Ste 180
Fairhaven, MA 02719
Phone (508) 973-2000

206 Mill Rd
Fairhaven, MA 02719
Phone (508) 973-3000

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

506 Prospect St
Fall River, MA 02720
Phone (508) 973-7888

Interoperability endpoints

  • Direct secure messaging: eothman12963@direct.southcoast.org

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.

Hospital & facility affiliations 2

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": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587600000000",
    "number": "1508916792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MILL RD",
            "address_2": "SUITE 180",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "027195252",
            "telephone_number": "508-973-2000",
            "fax_number": "508-973-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 MILL RD",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "027195208",
            "telephone_number": "508-973-3000",
            "fax_number": "508-973-3119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTHMAN",
        "first_name": "EDRESS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MA",
            "license": "254703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508916792",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eothman12963@direct.southcoast.org",
            "affiliation": "N",
            "endpointDescription": "Southcoast Health Epic Direct Address",
            "address_1": "206 Mill Rd",
            "city": "Fairhaven",
            "state": "MA",
            "country_code": "US",
            "postal_code": "027195208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fairhaven, MA

Sources for this page

Verify at the official NPI Registry.