Individual provider Active NPI

Gary John Nielan

Pediatric Adolescent Medicine Physician
Wilbraham, MA

National Provider Identifier

1568458479

Registry record updated Mar 7, 2023

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
Organizations & group practices1
NPI Registry JSON
Other providers in Wilbraham, MA
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License: 155058 Issued in MA
Practice address: 2207 Boston Rd
Wilbraham, MA 01095-1155
Phone: (413) 599-1201
Fax: (413) 596-2940
NPI assigned: Sep 26, 2005
Sex: Male
Sole proprietor: No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)	Code	License	State	Primary
Pediatric Adolescent Medicine Physician	2080A0000X	155058	MA	Primary

Addresses

Primary practice location

2207 Boston Rd
Wilbraham, MA 01095-1155

Mailing address

2207 Boston Rd
Wilbraham, MA 01095-1155
Phone (413) 599-1201

Other identifiers 15

Identifier	Type	State	Issuer
2017078	Other		AETNA/USHC
155058	Other		MA LICENSE
23378	Other		HEALTH NEW ENGLAND
28036	Other		CHILDRENS MEDICAL SECURIT
353451	Other		HEALTHSOURCE MA NH
J18133	Other		BCBS
102170	Other		CIGNA
1550588404	Other		CONNECTICARE
3182916	Medicaid	MA
1204585	Other		UNITED HEALTHCARE
155058	Other		TUFTS
975887	Other		NETWORK HEALTH
010155058MA01	Other		ANTHEM BCBS
201928	Other		HARVARD PILGRIM
000000008141	Other		BOSTON MED CENTER HEALTH

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 ID	State	Provider type	PAC ID	Details
I20160629001821	MA	Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine	6406038454

National Provider Directory

Medicare enrollment (NPD): Enrolled

State licenses

License	State	Type	Specialty
155058	MA	MD	Pediatric Adolescent Medicine Physician

Practice roles

Organization	Specialty	Status	New patients
George F Vitek MD & Associates PC	Adolescent Medicine	Past	Accepting new patients

Interoperability endpoints

Direct secure messaging: gnielan14104@direct.chppoc.masshiway.net

Organizations & group practices 1

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.

George F Vitek MD & Associates PC
- Pediatric Adolescent Medicine Physician
- Wilbraham, MA
- NPI 1457393506
NPD (past)

NPI Registry JSON

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1568458479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2207 BOSTON RD",
            "city": "WILBRAHAM",
            "state": "MA",
            "postal_code": "010951155",
            "telephone_number": "413-599-1201",
            "fax_number": "413-596-2940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2207 BOSTON RD",
            "city": "WILBRAHAM",
            "state": "MA",
            "postal_code": "010951155",
            "telephone_number": "413-599-1201",
            "fax_number": "413-596-2940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELAN",
        "first_name": "GARY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-26",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "MA",
            "license": "155058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA/USHC",
            "identifier": "2017078",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MA LICENSE",
            "identifier": "155058",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NEW ENGLAND",
            "identifier": "23378",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHILDRENS MEDICAL SECURIT",
            "identifier": "28036",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHSOURCE MA NH",
            "identifier": "353451",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "J18133",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "102170",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "1550588404",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3182916",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1204585",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "155058",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NETWORK HEALTH",
            "identifier": "975887",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "010155058MA01",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "201928",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOSTON MED CENTER HEALTH",
            "identifier": "000000008141",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilbraham, MA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.