Individual provider Active NPI

Keith Medeiros, M.D.

  • Cardiovascular Disease Physician
  • Marlborough, MA
National Provider Identifier
1699828566
Registry record updated Mar 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
240000 Issued in MA
Practice address
157 Union St
Marlborough, MA 01752-1228
Phone
(508) 624-9687
Fax
(508) 624-9689
NPI assigned
Jan 22, 2007
Last updated
Mar 16, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2022

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 240000 MA Primary
Nuclear Cardiology Physician 207UN0901X 240000 MA

Addresses

Primary practice location

157 Union St
Marlborough, MA 01752-1228

Mailing address

PO Box 415348
Boston, MA 02241-5348

Other identifiers 1

IdentifierTypeStateIssuer
110096402AMedicaidMA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kmedeiros11099@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
I20130905000583 MA Practitioner - Cardiovascular Disease (Cardiology) 5496998759 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Massachusetts Medical School, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Umass Memorial Medical Group IncGroup PAC ID 4284539891, 2,494 clinicians

Practice addresses (Care Compare)

112 Main St
Northborough, MA 01532-1914

119 Belmont St
Worcester, MA 01605-2903
Phone (508) 334-1000

154 E Main St
Westborough, MA 01581-1764

155 Union St
Marlborough, MA 01752-1228
Phone (508) 481-7390

157 Union St
Marlborough, MA 01752-1228
Phone (508) 486-5521

159 Union St
Suite 103
Marlborough, MA 01752-1274
Phone (508) 624-9687

198 Ayer Rd
Harvard, MA 01451-1163
Phone (978) 456-2355

201 Highland St
Suite B
Clinton, MA 01510-1037
Phone (978) 368-3731

333 SW Cutoff
Northborough, MA 01532-2130
Phone (774) 442-5695

340 Maple St
Suite 300
Marlborough, MA 01752-3200
Phone (508) 481-0202

378 Plantation St
Worcester, MA 01605-2324
Phone (508) 334-1000

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

60 Hospital Rd
Leominster, MA 01453-2205
Phone (978) 466-2257

640 Bolton St
Marlborough, MA 01752-3999
Phone (508) 481-0200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
82.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Marlborough Hospital Corp CurrentSince Mar 11, 2016 Accepting new patients
Umass Memorial Medical Center, Inc. CurrentSince Mar 11, 2016 Accepting new patients
Umass Memorial Medical Group Inc CurrentSince Dec 15, 2014 Accepting new patients
Umass Memorial Medical Group, Inc. CurrentSince Dec 15, 2014 Accepting new patients

Locations

157 Union St
Marlborough, MA 01752
Phone (508) 481-5000

159 Union St
Marlborough, MA 01752
Phone (508) 486-5454

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

Interoperability endpoints

  • Direct secure messaging: kmedeiros11099@umassmemorial.direct-ci.com

Organizations & group practices 4

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 4

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": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647388800000",
    "number": "1699828566",
    "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": "157 UNION ST",
            "city": "MARLBOROUGH",
            "state": "MA",
            "postal_code": "017521228",
            "telephone_number": "508-624-9687",
            "fax_number": "508-624-9689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDEIROS",
        "first_name": "KEITH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MA",
            "license": "240000",
            "primary": true
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "MA",
            "license": "240000",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110096402A",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmedeiros11099@UmassMemorial.direct-ci.com",
            "affiliation": "N",
            "address_1": "157 Union St",
            "city": "Marlborough",
            "state": "MA",
            "country_code": "US",
            "postal_code": "017521228",
            "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": "157 Union St",
            "city": "Marlborough",
            "state": "MA",
            "country_code": "US",
            "postal_code": "017521228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marlborough, MA

Sources for this page

Verify at the official NPI Registry.