Individual provider Active NPI

Jordan Siu

  • Internal Medicine Physician
  • Concord, MA
National Provider Identifier
1548624935
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5151010109 Issued in MI
Practice address
133 Old Road to 9 Acre Cor
Concord, MA 01742-4169
Phone
(586) 263-2972
NPI assigned
Apr 11, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5151010109 MI Primary

Addresses

Primary practice location

133 Old Road to 9 Acre Cor
Concord, MA 01742-4169

Mailing address

133 Ornac
Concord, MA 01742-4159

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
I20211018001692 MA Practitioner - Internal Medicine 3678820693 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
College of Osteo Med of the Pacific at Pomona, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emerson Practice Associates, IncGroup PAC ID 8123188117, 247 clinicians

Practice addresses (Care Compare)

133 Old Rd to 9 Acre Cor
Concord, MA 01742-4159
Phone (978) 287-3020

133 Old Rd to Nine Acre Corner
Mary Beth Misserville
Concord, MA 01742-4159

330 Brookline Ave
Boston, MA 02215-5400
Phone (617) 754-8612

330 Mount Auburn St
Cambridge, MA 02138-5502
Phone (781) 983-9088

Hospital & facility affiliations

  • Care Dimensions, Inc Hospice, Danvers, MA, CCN 221522
  • Mount Auburn Hospital Hospital, Cambridge, MA, CCN 220002
  • Beth Israel Deaconess Medical Center Hospital, Boston, MA, CCN 220086

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5151010109MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Aug 1, 2025 Accepting new patients
Emerson Practice Associates, Inc. Internal Medicine CurrentSince Aug 1, 2021 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc Internal Medicine CurrentSince Aug 1, 2025 Accepting new patients
Mount Auburn Hospital Past Accepting new patients
Emerson Hospital Past Accepting new patients

Locations

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

133 Ornac
Concord, MA 01742
Phone (978) 287-3000

9 Northeastern Blvd
Ste 400
Salem, NH 03079

Interoperability endpoints

  • Direct secure messaging: jsiu580630@direct.bilh.masshiway.net

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1460332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1548624935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 ORNAC",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017424159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 OLD ROAD TO 9 ACRE COR",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017424169",
            "telephone_number": "586-263-2972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIU",
        "first_name": "JORDAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-11",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5151010109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, MA

Sources for this page

Verify at the official NPI Registry.