Individual provider Active NPI

Joel M Gore, M.D.

  • Cardiovascular Disease Physician
  • Worcester, MA
National Provider Identifier
1659354132
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
43530 Issued in MA
Practice address
55 Lake Ave N
Department of Cardiovascular Medicine
Worcester, MA 01655-0002
Phone
(774) 441-6500
Fax
(774) 441-7657
NPI assigned
Nov 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 43530 MA Primary

Addresses

Primary practice location

55 Lake Ave N
Department of Cardiovascular Medicine
Worcester, MA 01655-0002

Mailing address

PO Box 415348
Boston, MA 02241-5348

Other identifiers 1

IdentifierTypeStateIssuer
0192538MedicaidMA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jgore22774@UmassMemorial.direct-ci.com
FHIR URL https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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
I20080327000592 MA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 7113985763 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43530MAMDCardiovascular Disease Physician

Interoperability endpoints

  • Direct secure messaging: jgore22774@umassmemorial.direct-ci.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1659354132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAKE AVE N",
            "address_2": "DEPARTMENT OF CARDIOVASCULAR MEDICINE",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016550002",
            "telephone_number": "774-441-6500",
            "fax_number": "774-441-7657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORE",
        "first_name": "JOEL",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-29",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MA",
            "license": "43530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0192538",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jgore22774@UmassMemorial.direct-ci.com",
            "affiliation": "N",
            "address_1": "55 Lake Ave N",
            "address_2": "Department of Cardiovascular Medicine",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016550002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "55 Lake Ave N",
            "address_2": "Department of Cardiovascular Medicine",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016550002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.