Active NPI
Theodore M Shoemaker, FAMILY PRACTICE
- Family Medicine Physician
- Worcester, MA
National Provider Identifier
1609888445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 59873
- Practice address
- 26 Queen St
Medical
Worcester, MA 01610-2473 - Phone
- (508) 860-7700
- Fax
- (508) 860-7990
- NPI assigned
- Aug 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 59873 | MA | Primary |
Addresses
Primary practice location
26 Queen St
Medical
Worcester, MA 01610-2473
Mailing address
26 Queen St
Medical
Worcester, MA 01610-2473
Phone (508) 860-7700
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0006767 | Other | MA | NHP-GROUP |
| Y10141 | Other | MA | BCBS-GROUP |
| F17619 | Other | MA | TRICARE/CHAMPUS |
| 2227022 | Other | MA | UNITED HEALTHCARE |
| 0002455 | Other | MA | NHP |
| 347296 | Other | MA | CIGNA |
| 042485308 | Other | MA | ADVANCED BENEFIT RESOUR |
| 042485308 | Other | MA | NETWORK HEALTH-GROUP |
| 14851 | Other | MA | FALLON SELECT |
| 99122301 | Other | MA | NETWORK HEALTH |
| 1300709 | Medicaid | MA | |
| 23481 | Other | MA | CMSP |
| Y02678 | Other | MA | BCBS |
| 042485308 | Other | MA | TRICARE/CHAMPUS-GROUP |
| 70952 | Other | MA | HARVARD PILGRIM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1609888445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26 QUEEN ST",
"address_2": "MEDICAL",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016102473",
"telephone_number": "508-860-7700",
"fax_number": "508-860-7990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 QUEEN ST",
"address_2": "MEDICAL",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016102473",
"telephone_number": "508-860-7700",
"fax_number": "508-860-7990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHOEMAKER",
"first_name": "THEODORE",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "FAMILY PRACTICE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-12",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MA",
"license": "59873",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NHP-GROUP",
"identifier": "0006767",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS-GROUP",
"identifier": "Y10141",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE/CHAMPUS",
"identifier": "F17619",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "2227022",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NHP",
"identifier": "0002455",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "347296",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ADVANCED BENEFIT RESOUR",
"identifier": "042485308",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NETWORK HEALTH-GROUP",
"identifier": "042485308",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FALLON SELECT",
"identifier": "14851",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NETWORK HEALTH",
"identifier": "99122301",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1300709",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CMSP",
"identifier": "23481",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "Y02678",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE/CHAMPUS-GROUP",
"identifier": "042485308",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "70952",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.