NPIMap

Individual provider Active NPI

Peter B Gibson, MD

  • Cardiovascular Disease Physician
  • Worcester, MA
National Provider Identifier
1528028057
Registry record updated Dec 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
154005 Issued in MA
Practice address
55 Lake Ave N
Department of Medicine
Worcester, MA 01655-0002
Phone
(508) 856-3452
Fax
(508) 856-4571
NPI assigned
Mar 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 154005 MA Primary

Addresses

Primary practice location

55 Lake Ave N
Department of Medicine
Worcester, MA 01655-0002

Mailing address

PO Box 415348
Boston, MA 02241-5348
Phone (800) 225-8885

Other identifiers 1

IdentifierTypeStateIssuer
PG40958MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NH2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051004000766 MA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 6305879966 Reassigns benefits to 3 organizations
I20220617000190 NH Practitioner - Cardiovascular Disease (Cardiology) 6305879966 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Cincinnati College of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Joseph Hospital of Nashua NHGroup PAC ID 2062455611, 271 clinicians

Practice addresses (Care Compare)

172 Kinsley St
Nashua, NH 03060-3648
Phone (603) 884-5600

Hospital & facility affiliations

  • St Joseph Hospital Hospital, Nashua, NH, CCN 300011
  • Southern NH Medical Center Hospital, Nashua, NH, CCN 300020
  • Elliot Hospital Hospital, Manchester, NH, CCN 300012
  • Mary Hitchcock Memorial Hospital Hospital, Lebanon, NH, CCN 300003

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Catholic Medical Center CurrentSince May 31, 2022 Accepting new patients
Heywood Medical Group Inc. Cardiovascular Disease CurrentSince Mar 1, 2019 Accepting new patients
Athol Memorial Hospital Incorporated Cardiovascular Disease CurrentSince Mar 1, 2019 Accepting new patients
St Joseph Hospital of Nashua NH Current Accepting new patients
Henry Heywood Memorial Hospital Cardiovascular Disease CurrentSince Mar 1, 2019 Accepting new patients
St Joseph Hospital of Nashua NH CurrentSince Jun 1, 2022 Accepting new patients
Catholic Medical Center Cardiovascular Disease CurrentSince May 31, 2022 Accepting new patients
Henry Heywood Memorial Hospital CurrentSince Mar 1, 2019 Accepting new patients
Blackstone Cardiology Associates Cardiovascular Disease Past Accepting new patients
St Joseph Hospital of Nashua NH Past Accepting new patients

Locations

2033 Main St
Athol, MA 01331
Phone (978) 249-1295

242 Green St
Gardner, MA 01440
Phone (978) 258-4734

250 Green St
Gardner, MA 01440
Phone (978) 630-5050

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

100 McGregor St
Manchester, NH 03102
Phone (603) 663-6931

172 Kinsley St
Nashua, NH 03060
Phone (603) 595-3926

Interoperability endpoints

  • Direct secure messaging: pgibson1257003@direct.bsmhealth.org

Organizations & group practices 10

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 6

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": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291593600000",
    "number": "1528028057",
    "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",
            "telephone_number": "800-225-8885",
            "fax_number": "508-334-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAKE AVE N",
            "address_2": "DEPARTMENT OF MEDICINE",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016550002",
            "telephone_number": "508-856-3452",
            "fax_number": "508-856-4571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "PETER",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-27",
        "last_updated": "2010-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MA",
            "license": "154005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PG40958",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.