NPIMap

Organization Active NPI

Lahey Clinic, Inc.

  • Internal Medicine Physician
  • Derry, NH
National Provider Identifier
1669491601
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2778 Issued in NH
Legal business name
LAHEY CLINIC, INC.
Practice address
1 Parkland Dr
Derry, NH 03038-2746
Phone
(603) 421-2156
NPI assigned
Jul 19, 2006
Last updated
Oct 17, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
BETH ISRAEL LAHEY HEALTH INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Authorized official

Name
Susan D Moffatt-Bruce, MD
Title
President
Phone
(781) 744-8594

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2778 NH Primary

Addresses

Primary practice location

1 Parkland Dr
Derry, NH 03038-2746

Mailing address

41 Mall Rd
Burlington, MA 01805-0001
Phone (781) 744-8085

Other identifiers 1

IdentifierTypeStateIssuer
30005078MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050210000610 NH Part B Supplier - Clinic/Group Practice 2264336528 Receives reassigned benefits from 51 practitioners
Practice locations: Salem, NH; Portsmouth, NH; Nashua, NH; Derry, NH

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

41 Mall Rd
Burlington, MA 01805
Phone (781) 744-8085

Practitioners & affiliated clinicians

Practitioners 51

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 51

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1669491601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 MALL RD",
            "city": "BURLINGTON",
            "state": "MA",
            "postal_code": "018050001",
            "telephone_number": "781-744-8085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PARKLAND DR",
            "city": "DERRY",
            "state": "NH",
            "postal_code": "030382746",
            "telephone_number": "603-421-2156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAHEY CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BETH ISRAEL LAHEY HEALTH INC",
        "enumeration_date": "2006-07-19",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "MOFFATT-BRUCE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-744-8594",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NH",
            "license": "2778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30005078",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Derry, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.