Individual provider Active NPI

Michael J O'Brien, MD

  • Anatomic Pathology Physician
  • Boston, MA
National Provider Identifier
1700858438
Registry record updated Oct 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology PhysicianTaxonomy code 207ZP0101X
License
40684 Issued in MA
Practice address
670 Albany St
Floor 3, Room 310
Boston, MA 02118-2646
Phone
(617) 414-5314
Fax
(617) 414-5315
NPI assigned
Feb 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology Physician 207ZP0101X 40684 MA Primary

Addresses

Primary practice location

670 Albany St
Floor 3, Room 310
Boston, MA 02118-2646

Mailing address

1085 Main St
South Weymouth, MA 02190-1547

Other identifiers 2

IdentifierTypeStateIssuer
30204395MedicaidNH
6169813MedicaidMA

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
I20050407000271 MA Practitioner - Pathology 6002705852 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1971
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Suburban Gastroenterology PCGroup PAC ID 9931194412, 50 clinicians

Practice addresses (Care Compare)

97 Libbey Pkwy
Suite 300
Weymouth, MA 02189-3110
Phone (781) 331-2922

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
40684MAMDAnatomic Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Suburban Gastroenterology, PC CurrentSince Jan 1, 2011 Accepting new patients
Evans Medical Foundation, Inc. Past Accepting new patients
Weymouth Endoscopy, LLC PastSince Jan 1, 2011 Accepting new patients

Locations

97 Libbey Park
Ste 300
Weymouth, MA 02189
Phone (781) 331-2922

1085 Main St
Weymouth, MA 02190
Phone (781) 331-2922

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 and National Provider Directory roles.

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": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570752000000",
    "number": "1700858438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1085 MAIN ST",
            "city": "SOUTH WEYMOUTH",
            "state": "MA",
            "postal_code": "021901547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 ALBANY ST",
            "address_2": "FLOOR 3, ROOM 310",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182646",
            "telephone_number": "617-414-5314",
            "fax_number": "617-414-5315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-06",
        "last_updated": "2019-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "MA",
            "license": "40684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30204395",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6169813",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.