NPIMap

Organization Active NPI

Pentucket Medical Associates, LLC

  • Internal Medicine Physician
  • Haverhill, MA
National Provider Identifier
1609872886
Registry record updated Jun 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PENTUCKET MEDICAL ASSOCIATES, LLC
Practice address
One Parkway
Haverhill, MA 01830
Phone
(978) 521-3200
Fax
(978) 469-5363
NPI assigned
Jun 22, 2005
Last updated
Jun 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2011

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

Authorized official

Name
Dr. Thomas Louis Fazio, M.D.
Title
Managing Partner
Phone
(978) 557-8920

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy Physician 207KA0200X NU
Family Medicine Physician 207Q00000X NU
Geriatric Medicine (Family Medicine) Physician 207QG0300X NU
Internal Medicine Physician 207R00000X NU Primary
Cardiovascular Disease Physician 207RC0000X NU
Endocrinology, Diabetes & Metabolism Physician 207RE0101X NU
Gastroenterology Physician 207RG0100X NU
Geriatric Medicine (Internal Medicine) Physician 207RG0300X NU
Interventional Cardiology Physician 207RI0011X NU
Infectious Disease Physician 207RI0200X NU
Nephrology Physician 207RN0300X NU
Pulmonary Disease Physician 207RP1001X NU
Nuclear Cardiology Physician 207UN0901X NU
Pediatrics Physician 208000000X NU
Pediatric Adolescent Medicine Physician 2080A0000X NU

Addresses

Primary practice location

One Parkway
Haverhill, MA 01830

Mailing address

One Parkway
Haverhill, MA 01830
Phone (978) 521-3200

Other identifiers 6

IdentifierTypeStateIssuer
M17320OtherMABCBS
30210443OtherNHNH MEDICAID
5313652OtherAETNA
681017OtherMATUFTS
0018028OtherMANEIGHBORHOOD HEALTH PLAN
9786376MedicaidMA

National Provider Directory

National Provider Directory

Locations

360 Merrimack St
Ste 1
Lawrence, MA 01843
Phone (978) 557-8800

Interoperability endpoints

  • Direct secure messaging: abele.michael.pma@direct.partners.masshiway.net
  • Direct secure messaging: andrade.jessica.pma@direct.partners.masshiway.net
  • Direct secure messaging: armitage.marshal.pma@direct.partners.masshiway.net
  • Direct secure messaging: assoulinedayan.yehudith.pma@direct.partners.masshiway.net
  • Direct secure messaging: badessa.kimberly.pma@direct.partners.masshiway.net
  • Direct secure messaging: beaudoin.stephen.pma@direct.partners.masshiway.net
  • Direct secure messaging: bickley.barry.pma@direct.partners.masshiway.net
  • Direct secure messaging: bodine.warren.pma@direct.partners.masshiway.net
  • Direct secure messaging: bolognese.sherri.pma@direct.partners.masshiway.net
  • Direct secure messaging: boulanger.paula.pma@direct.partners.masshiway.net
  • Direct secure messaging: brennan.beverly.pma@direct.partners.masshiway.net
  • Direct secure messaging: burke.kelly.pma@direct.partners.masshiway.net
  • Direct secure messaging: burnham.kimberly.pma@direct.partners.masshiway.net
  • Direct secure messaging: cammarata.constance.pma@direct.partners.masshiway.net
  • Direct secure messaging: carney.katelyn.pma@direct.partners.masshiway.net
  • Direct secure messaging: cashman.katelin.pma@direct.partners.masshiway.net
  • Direct secure messaging: challagulla.madhavi.pma@direct.partners.masshiway.net
  • Direct secure messaging: cocchiaro.christine.pma@direct.partners.masshiway.net
  • Direct secure messaging: coelho.ester.pma@direct.partners.masshiway.net
  • Direct secure messaging: cohen.aaron.pma@direct.partners.masshiway.net

Practitioners & affiliated clinicians

Practitioners 98

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 98

NPI Registry JSON

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308096000000",
    "number": "1609872886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE PARKWAY",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "01830",
            "telephone_number": "978-521-3200",
            "fax_number": "978-374-9792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE PARKWAY",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "01830",
            "telephone_number": "978-521-3200",
            "fax_number": "978-469-5363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENTUCKET MEDICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2011-06-15",
        "status": "A",
        "authorized_official_last_name": "FAZIO",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "978-557-8920",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "M17320",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NH MEDICAID",
            "identifier": "30210443",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5313652",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "681017",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH PLAN",
            "identifier": "0018028",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9786376",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Haverhill, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.