Individual provider Active NPI

Timothy P Fitzgibbons, M.D.

  • Cardiovascular Disease Physician
  • Worcester, MA
National Provider Identifier
1710911565
Registry record updated Oct 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
226410 Issued in MA
Practice address
55 Lake Ave N
Department of Cardiology
Worcester, MA 01655-0002
Phone
(508) 334-3452
Fax
(774) 441-7657
NPI assigned
Jul 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 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 226410 MA Primary

Addresses

Primary practice location

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

Mailing address

PO Box 415348
Boston, MA 02241-5348

Other identifiers 1

IdentifierTypeStateIssuer
110093345AMedicaidMA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address tfitzgibbons11090@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
I20121012000161 MA Practitioner - Cardiovascular Disease (Cardiology) 9739338450 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Loyola University of Chicago, Stritch School of Medicine, 2002
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)

116 Belmont St
RM 11
Worcester, MA 01605-2964
Phone (508) 334-1102

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

151 Worcester Rd
Barre, MA 01005-9002
Phone (978) 355-6321

188 Worcester Prov Tpke
Sutton, MA 01590-1908
Phone (508) 865-3650

242 Woodland St
West Boylston, MA 01583-1670
Phone (508) 835-6221

26 Julio Dr
Shrewsbury, MA 01545-3020
Phone (508) 845-2323

279 Lincoln St
Worcester, MA 01605-2120
Phone (508) 334-8830

281 E Hartford Ave
Uxbridge, MA 01569-1278
Phone (508) 278-5573

281 Lincoln St
Worcester, MA 01605-2138
Phone (508) 334-1000

291 Lincoln St
Worcester, MA 01605-3643

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

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

489 Washington St
Auburn, MA 01501-5709
Phone (508) 832-9646

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

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

604 Main St
Shrewsbury, MA 01545-5663
Phone (508) 842-6502

65 Canal St
Millbury, MA 01527-3266
Phone (508) 865-9960

91 Water St
Milford, MA 01757-3039
Phone (508) 458-4250

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
Umass Memorial Medical Group, Inc. CurrentSince Sep 1, 2012 Accepting new patients
Umass Memorial Radiology Phys Serv CurrentSince Feb 1, 2020 Accepting new patients
Umass Memorial Medical Group Inc CurrentSince Sep 1, 2012 Accepting new patients
Umass Memorial Medical Center, Inc. Past Accepting new patients

Locations

91 Water St
Milford, MA 01757
Phone (508) 458-4250

100 South St
Southbridge, MA 01550
Phone (508) 764-8012

340 Thompson Rd
Webster, MA 01570
Phone (508) 943-2600

10 Little Brook Rd
West Wareham, MA 02576

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

Interoperability endpoints

  • Direct secure messaging: tfitzgibbons11090@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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604102400000",
    "number": "1710911565",
    "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 CARDIOLOGY",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016550002",
            "telephone_number": "508-334-3452",
            "fax_number": "774-441-7657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGIBBONS",
        "first_name": "TIMOTHY",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2020-10-31",
        "certification_date": "2020-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MA",
            "license": "226410",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110093345A",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tfitzgibbons11090@UmassMemorial.direct-ci.com",
            "affiliation": "N",
            "address_1": "55 Lake Ave N",
            "address_2": "Department of Cardiology",
            "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 Cardiology",
            "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.