Individual provider Active NPI

Joann S Ganim, M.D.

  • Pediatrics Physician
  • Peabody, MA
National Provider Identifier
1568440477
Registry record updated Oct 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
79065 Issued in MA
Practice address
2 Essex Center Dr
Peabody, MA 01960-2902
Phone
(978) 977-4300
Fax
(978) 977-4313
NPI assigned
Jan 3, 2006
Last updated
Oct 26, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 79065 MA Primary

Addresses

Primary practice location

2 Essex Center Dr
Peabody, MA 01960-2902

Mailing address

2 Essex Center Dr
Peabody, MA 01960-2926
Phone (978) 977-4300

Other identifiers 5

IdentifierTypeStateIssuer
3129004MedicaidMA
079065OtherMATUFTS
0011300OtherMANEIGHBORHOOD HEALTH
J30907OtherMABLUE CROSS
PP842OtherMAHARVARD PILGRIM

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jganimmd11851@direct.atrius.masshiway.net

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
I20050726000267 MA Practitioner - Pediatric Medicine 2567499148 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Rutgers R W Johnson Medical School (Cam/New Bruns/Pisc), 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atrius Health IncGroup PAC ID 4789588641, 1,214 clinicians

Practice addresses (Care Compare)

133 Brookline Ave
Boston, MA 02215-3904
Phone (617) 421-1000

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Atrius Health, Inc. Pediatrics Current Accepting new patients
Atrius Health, Inc. CurrentSince Nov 4, 2016 Accepting new patients
Atrius Health, Inc. Pediatrics Past Accepting new patients

Locations

77 Herrick St
Ste 101
Beverly, MA 01915
Phone (978) 232-7115

133 Brookline Ave
Boston, MA 02215
Phone (617) 421-1000

147 Milk St
Fl 9
Boston, MA 02109
Phone (617) 559-8051

2 Essex Center Dr
Ste 1
Peabody, MA 01960
Phone (978) 977-4000

2 Essex Dr
Peabody, MA 01960
Phone (978) 977-4000

Interoperability endpoints

  • Direct secure messaging: jganimmd11851@direct.atrius.masshiway.net

Organizations & group practices 3

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1568440477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 ESSEX CENTER DR",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019602926",
            "telephone_number": "978-977-4300",
            "fax_number": "978-977-4313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 ESSEX CENTER DR",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019602902",
            "telephone_number": "978-977-4300",
            "fax_number": "978-977-4313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANIM",
        "first_name": "JOANN",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-03",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "79065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3129004",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "079065",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH",
            "identifier": "0011300",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "J30907",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "PP842",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jganimmd11851@direct.atrius.masshiway.net",
            "affiliation": "N",
            "address_1": "2 Essex Center Dr",
            "city": "Peabody",
            "state": "MA",
            "country_code": "US",
            "postal_code": "019602902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Peabody, MA

Sources for this page

Verify at the official NPI Registry.