NPIMap

Organization Active NPI

ICU on Demand, PLLC

  • Critical Care Medicine (Anesthesiology) Physician
  • Westwood, MA
National Provider Identifier
1609692045
Registry record updated Dec 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Anesthesiology) PhysicianTaxonomy code 207LC0200X
Legal business name
ICU ON DEMAND, PLLC
Practice address
15 Little Boot LN
Westwood, MA 02090-2648
Phone
(104) 692-5292
NPI assigned
Dec 2, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2024

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

Authorized official

Name
Khald Sorour, MD
Title
Owner
Phone
(401) 692-5292

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LC0200X Primary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Critical Care Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0200X

Addresses

Primary practice location

15 Little Boot LN
Westwood, MA 02090-2648

Mailing address

15 Little Boot LN
Westwood, MA 02090-2648

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, NH, TN, PA, CT, ME, MA7 enrollments

Enrollment records 7

Enrollment IDStateProvider typePAC IDDetails
O20250207000575 RI Part B Supplier - Clinic/Group Practice 3072043983 Receives reassigned benefits from 6 practitioners
Practice locations: Johnston, RI
O20250530000440 NH Part B Supplier - Clinic/Group Practice 3072043983 Receives reassigned benefits from 6 practitioners
Practice locations: Concord, NH
O20251113001837 TN Part B Supplier - Clinic/Group Practice 3072043983 Receives reassigned benefits from 3 practitioners
Practice locations: Franklin, TN
O20251205002317 PA Part B Supplier - Clinic/Group Practice 3072043983 Receives reassigned benefits from 3 practitioners
Practice locations: Erie, PA; Mechanicsburg, PA; Reading, PA; York, PA
O20260106001858 CT Part B Supplier - Clinic/Group Practice 3072043983 Receives reassigned benefits from 3 practitioners
Practice locations: Danbury, CT
O20260106003170 ME Part B Supplier - Clinic/Group Practice 3072043983 Receives reassigned benefits from 2 practitioners
Practice locations: Portland, ME
O20260205000033 MA Part B Supplier - Clinic/Group Practice 3072043983 Receives reassigned benefits from 9 practitioners
Practice locations: Newburyport, MA; Woburn, MA; Worcester, MA

National Provider Directory

National Provider Directory

Locations

143 E 2nd St
Erie, PA 16507
Phone (814) 878-1200

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1733097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733097600000",
    "number": "1609692045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 LITTLE BOOT LN",
            "city": "WESTWOOD",
            "state": "MA",
            "postal_code": "020902648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 LITTLE BOOT LN",
            "city": "WESTWOOD",
            "state": "MA",
            "postal_code": "020902648",
            "telephone_number": "104-692-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICU ON DEMAND, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-02",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A",
        "authorized_official_last_name": "SOROUR",
        "authorized_official_first_name": "KHALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "401-692-5292",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westwood, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.