Individual provider Active NPI

Peter Mark Grzesik, DO

  • Anesthesiology Physician
  • Worcester, MA
National Provider Identifier
1518378231
Registry record updated Jul 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
287786 Issued in MA
Practice address
55 Lake Ave N
Worcester, MA 01655-0002
Phone
(508) 334-3271
Fax
(508) 856-5911
NPI assigned
May 15, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 287786 MA Primary

Addresses

Primary practice location

55 Lake Ave N
Worcester, MA 01655-0002

Mailing address

PO Box 415348
Boston, MA 02241-5348

Other practice location 1

20 York St
New Haven, CT 06510-3220
Phone (203) 688-4242

Other practice location 2

24 Hospital Ave
Danbury, CT 06810-6099
Phone (203) 739-7000

Other identifiers 1

IdentifierTypeStateIssuer
110126355AMedicaidMA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address pgrzesik28715@UmassMemorial.direct-ci.com
FHIR URL https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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
I20210809002121 MA Practitioner - Anesthesiology 4082912928 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
New York College of Osteo Medicine of New York Institute of Technology, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Umass Memorial Medical Group IncGroup PAC ID 4284539891, 2,494 clinicians

Practice addresses (Care Compare)

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

Hospital & facility affiliations

  • Umass Memorial Medical Center/University Campus Hospital, Worcester, MA, CCN 220163

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
82.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Umass Memorial Medical Group, Inc. CurrentSince Jul 1, 2021 Accepting new patients
Umass Memorial Medical Group Inc Anesthesiology CurrentSince Jul 1, 2021 Accepting new patients

Locations

281 Lincoln St
Worcester, MA 01605
Phone (508) 334-8015

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

Interoperability endpoints

  • Direct secure messaging: pgrzesik28715@umassmemorial.direct-ci.com

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.

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": "1400112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627516800000",
    "number": "1518378231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAKE AVE N",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016550002",
            "telephone_number": "508-334-3271",
            "fax_number": "508-856-5911"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 York St",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065103220",
            "country_code": "US",
            "telephone_number": "203-688-4242",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24 Hospital Ave",
            "address_purpose": "LOCATION",
            "city": "Danbury",
            "state": "CT",
            "postal_code": "068106099",
            "country_code": "US",
            "telephone_number": "203-739-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRZESIK",
        "first_name": "PETER",
        "middle_name": "MARK",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-15",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MA",
            "license": "287786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110126355A",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pgrzesik28715@UmassMemorial.direct-ci.com",
            "affiliation": "N",
            "address_1": "55 Lake Ave N",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016550002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "55 Lake Ave N",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016550002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.