NPIMap

Organization Active NPI

North Shore Geriatric Associates

  • Geriatric Medicine (Internal Medicine) Physician
  • Beverly, MA
National Provider Identifier
1730235565
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
60080 Issued in MA
Legal business name
NORTH SHORE GERIATRIC ASSOCIATES
Practice address
75 Brimbal Ave
Beverly, MA 01915-6009
Phone
(978) 469-0649
NPI assigned
Jan 26, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Keith J Champney, M.D.
Title
Physician
Phone
(978) 469-0649

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 60080 MA Primary

Addresses

Primary practice location

75 Brimbal Ave
Beverly, MA 01915-6009

Mailing address

100 Cummings Ctr Ste 232C
Beverly, MA 01915-6126
Phone (978) 998-6799

Other identifiers 1

IdentifierTypeStateIssuer
M19173OtherMABLUE SHIELD

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730235565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CUMMINGS CTR STE 232C",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156126",
            "telephone_number": "978-998-6799",
            "fax_number": "978-998-6803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 BRIMBAL AVE",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156009",
            "telephone_number": "978-469-0649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE GERIATRIC ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHAMPNEY",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "978-469-0649",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MA",
            "license": "60080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "M19173",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.