NPIMap

Individual provider Active NPI

Suhas Sreeharshan

  • Family Medicine Physician
  • Bolton, MA
National Provider Identifier
1689179111
Registry record updated Sep 3, 2021
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Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
28617 Issued in MA
Practice address
563 Main St
Bolton, MA 01740-1300
Phone
(978) 586-3939
Fax
(978) 586-3944
NPI assigned
Mar 27, 2018
Last updated
Sep 3, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 28617 MA Primary

Addresses

Primary practice location

563 Main St
Bolton, MA 01740-1300

Mailing address

PO Box 415348
Boston, MA 02241-5348
Phone (800) 225-8885

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210909003318 MA Practitioner - Family Practice 0840547642 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Umass Memorial Medical Group IncGroup PAC ID 4284539891, 2,494 clinicians

Practice addresses (Care Compare)

563 Main St
Suite 3
Bolton, MA 01740-1300
Phone (978) 586-3939

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28617MAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Umass Memorial Medical Group Inc Family Medicine CurrentSince Sep 2, 2021 Accepting new patients
Umass Memorial Medical Group, Inc. CurrentSince Sep 2, 2021 Accepting new patients

Locations

151 Worcester Rd
Barre, MA 01005
Phone (978) 355-6321

563 Main St
Ste 3
Bolton, MA 01740
Phone (978) 586-3939

281 Lincoln St
Worcester, MA 01605
Phone (508) 334-8015

281 Lincoln St
#2212A
Worcester, MA 01605

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

Organizations & group practices 2

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 8

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": "1522108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630627200000",
    "number": "1689179111",
    "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",
            "telephone_number": "800-225-8885",
            "fax_number": "508-334-8105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "563 MAIN ST",
            "city": "BOLTON",
            "state": "MA",
            "postal_code": "017401300",
            "telephone_number": "978-586-3939",
            "fax_number": "978-586-3944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SREEHARSHAN",
        "first_name": "SUHAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-27",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "28617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolton, MA

Sources for this page

Verify at the official NPI Registry.