Individual provider Active NPI

Jacob Dal-Bianco, MD

  • Cardiovascular Disease Physician
  • Boston, MA
National Provider Identifier
1639188840
Registry record updated Mar 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
253818 Issued in MA
Practice address
55 Fruit St
Yawkey 5a
Boston, MA 02114-2621
Phone
(617) 724-2076
Fax
(617) 643-3963
NPI assigned
Aug 5, 2006
Last updated
Mar 8, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 253818 MA Primary
Internal Medicine Physician 207R00000X 253818 MA

Addresses

Primary practice location

55 Fruit St
Yawkey 5a
Boston, MA 02114-2621

Mailing address

PO Box 9142
Charlestown, MA 02129-9142
Phone (617) 724-2076

Other identifiers 2

IdentifierTypeStateIssuer
110094427/AMedicaidMA
612935000MedicaidMN

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
I20130124000342 MA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 0143225557 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

102 Endicott St
MGH North Shore Medical
Danvers, MA 01923-3623
Phone (978) 882-6100

115 Mill St
Belmont, MA 02478-1064
Phone (617) 643-0003

151 Everett Ave
Chelsea, MA 02150-1812
Phone (617) 884-8300

19 Norwood St
Everett, MA 02149-2709
Phone (617) 394-7500

243 Charles St
Suite 1107
Boston, MA 02114-3002
Phone (617) 273-5699

25 New Chardon St
301 MGH Heart Center
Boston, MA 02114-4774
Phone (617) 726-1843

300 Ocean Ave
Revere, MA 02151-3675
Phone (781) 485-6300

385 Broadway
Revere, MA 02151-3033
Phone (617) 267-7171

388 Commonwealth Ave
Boston, MA 02215-2800
Phone (617) 267-7171

440 Foley St
Somerville, MA 02145-1213
Phone (857) 282-0777

50 Staniford St
Boston, MA 02114-2517

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

57 Prospect St
Nantucket, MA 02554-2799
Phone (508) 825-8100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
253818MAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The General Hospital Corporation CurrentSince Dec 1, 2012 Accepting new patients
General Hospital Corp Current Accepting new patients
Massachusetts General Physicians Organization Inc Internal Medicine CurrentSince Dec 1, 2012 Accepting new patients

Locations

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

55 Fruit St
#5A
Boston, MA 02114
Phone (617) 724-2076

Interoperability endpoints

  • Direct secure messaging: dal-bianco.jacob.mgh@direct.partners.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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362700800000",
    "number": "1639188840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9142",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021299142",
            "telephone_number": "617-724-2076",
            "fax_number": "617-643-3963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "address_2": "YAWKEY 5A",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-724-2076",
            "fax_number": "617-643-3963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAL-BIANCO",
        "first_name": "JACOB",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2013-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MA",
            "license": "253818",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "253818",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110094427/A",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "612935000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.