NPIMap

Individual provider Active NPI

Shady Fattoum, M.D

  • Internal Medicine Physician
  • South Weymouth, MA
National Provider Identifier
1538575915
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
270697 Issued in MA
Practice address
55 Fogg Rd
South Weymouth, MA 02190-2432
Phone
(781) 624-8000
NPI assigned
Jul 7, 2014
Last updated
Feb 7, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X 270697 MA Primary

Addresses

Primary practice location

55 Fogg Rd
South Weymouth, MA 02190-2432

Mailing address

55 Fogg Rd
South Weymouth, MA 02190-2432
Phone (781) 624-8000

Other practice location 1

1555 Long Pond Rd
Rochester, NY 14626-4122
Phone (585) 723-7769

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171016003021 MA Practitioner - HospitalistPractitioner - Internal Medicine 6204055726 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mass General Brigham Medical Group, Inc.Group PAC ID 3971987108, 140 clinicians
Coastal Medical AssociatesGroup PAC ID 7113029257, 443 clinicians

Practice addresses (Care Compare)

1153 Centre St
Jamaica Plain, MA 02130-3446
Phone (617) 726-4121

2014 Washington St
Newton, MA 02462-1607
Phone (617) 243-6040

47 Middlesex Tpke
Burlington, MA 01803-4945
Phone (857) 282-8100

55 Fogg Rd
Weymouth, MA 02190-2432
Phone (781) 792-4136

55 Fruit St
Boston, MA 02114-2621
Phone (617) 726-4121

75 Francis St
Boston, MA 02115-6110
Phone (617) 726-4121

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue469
Removal of skin lesions16
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
270697MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mass General Brigham Medical Group, Inc. Internal Medicine CurrentSince Jul 1, 2024 Accepting new patients
Coastal Medical Associates CurrentSince Aug 1, 2017 Accepting new patients
Circle Medical Team LLC Internal Medicine CurrentSince Apr 1, 2024 Accepting new patients
Deutsches Altenheim Inc. Past Accepting new patients
Brigham and Women's Faulkner Hospital Inc Past Accepting new patients

Locations

47 Middlesex Tpke
Burlington, MA 01803
Phone (857) 282-8100

95 Washington St
Ste 224177
Canton, MA 02021

305 Walpole St
Norwood, MA 02062
Phone (781) 366-0310

55 Fogg Rd
Weymouth, MA 02190
Phone (781) 340-4293

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1404691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1538575915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 FOGG RD",
            "city": "SOUTH WEYMOUTH",
            "state": "MA",
            "postal_code": "021902432",
            "telephone_number": "781-624-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FOGG RD",
            "city": "SOUTH WEYMOUTH",
            "state": "MA",
            "postal_code": "021902432",
            "telephone_number": "781-624-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1555 Long Pond Rd",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146264122",
            "country_code": "US",
            "telephone_number": "585-723-7769",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FATTOUM",
        "first_name": "SHADY",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-07",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "270697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Weymouth, MA

Sources for this page

Verify at the official NPI Registry.