Individual provider Active NPI

Gerardo Gonzalez-Haddad, M.D.

  • Psychiatry Physician
  • Worcester, MA
National Provider Identifier
1720168271
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
236025 Issued in MA
Practice address
100 Century Dr
Worcester, MA 01606-1244
Phone
(508) 762-5400
Fax
(508) 762-5410
NPI assigned
Oct 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Psychiatry Physician 2084P0802X 236025 MA
Psychiatry Physician 2084P0800X 236025 MA Primary

Addresses

Primary practice location

100 Century Dr
Worcester, MA 01606-1244

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
110079917AMedicaidMA

Other names 1

  • Gerardo Gonzalez Professional name

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
Direct Messaging Address ggonzalez127028@UmassMemorial.direct-ci.com

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
I20080808000651 MA Practitioner - Psychiatry 1052485034 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
236025MAMDAddiction Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The McLean Hospital Corporation Psychiatry CurrentSince Jul 1, 2022 Accepting new patients
McLean Hospital Past Accepting new patients
The McLean Hospital Corporation Past Accepting new patients
State of Connecticut Past Accepting new patients

Locations

115 Mill St
Belmont, MA 02478
Phone (617) 855-2000

23 Isaac St
Middleboro, MA 02346
Phone (774) 419-1000

Interoperability endpoints

  • Direct secure messaging: ggonzalez127028@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.

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1720168271",
    "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": "508-334-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CENTURY DR",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016061244",
            "telephone_number": "508-762-5400",
            "fax_number": "508-762-5410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ-HADDAD",
        "first_name": "GERARDO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "MA",
            "license": "236025",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "236025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110079917A",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "100 Century Dr",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016061244",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ggonzalez127028@UmassMemorial.direct-ci.com",
            "affiliation": "N",
            "address_1": "100 Century Dr",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016061244",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "GERARDO",
            "last_name": "GONZALEZ",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.