Individual provider Active NPI

Jennifer E Fishbein, MD

  • Pediatric Nephrology Physician
  • Worcester, MA
National Provider Identifier
1730611260
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nephrology PhysicianTaxonomy code 2080P0210X
License
282857 Issued in MA
Practice address
55 Lake Ave N
Worcester, MA 01655-0002
Phone
(774) 442-2131
Fax
(774) 443-7399
NPI assigned
Apr 3, 2017
Last updated
Aug 6, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 282857 MA
Pediatric Nephrology Physician 2080P0210X MD19375 RI
Pediatric Nephrology Physician 2080P0210X 282857 MA Primary

Addresses

Primary practice location

55 Lake Ave N
Worcester, MA 01655-0002

Mailing address

PO Box 415348 Umass Memorial Medical Group
Boston, MA 02241-5348
Phone (800) 225-8885

Other practice location 1

900 Warren Ave Ste 201
East Providence, RI 02914-1430
Phone (401) 444-8306

Other identifiers 1

IdentifierTypeStateIssuer
110161115AMedicaidMA

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, RI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230825002070 MA Practitioner - NephrologyPractitioner - Pediatric Medicine 8325401185 Reassigns benefits to 1 organization
I20231002002853 RI Practitioner - Pediatric Medicine 8325401185 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD19375RIMDPediatric Nephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. CurrentSince Oct 1, 2023 Accepting new patients
Lifespan Physician Group, Inc. Pediatrics CurrentSince Oct 1, 2023 Accepting new patients
Umass Memorial Medical Group Inc Pediatrics CurrentSince Aug 11, 2023 Accepting new patients
Rhode Island Hospital Pediatrics CurrentSince Oct 1, 2023 Accepting new patients
Rhode Island Hospital CurrentSince Oct 1, 2023 Accepting new patients
Umass Memorial Medical Group, Inc. CurrentSince Aug 11, 2023 Accepting new patients

Locations

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

900 Warren Ave
Ste 201
East Providence, RI 02914
Phone (401) 444-5980

701 George Washington Hwy
Ste 104
Lincoln, RI 02865
Phone (401) 444-8311

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

593 Eddy St
Ste 105
Providence, RI 02903
Phone (401) 444-5241

593 Eddy St
Ste 5
Providence, RI 02903
Phone (401) 444-3996

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1491177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1730611260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348 UMASS MEMORIAL MEDICAL GROUP",
            "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": "55 LAKE AVE N",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016550002",
            "telephone_number": "774-442-2131",
            "fax_number": "774-443-7399"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 Warren Ave Ste 201",
            "address_purpose": "LOCATION",
            "city": "East Providence",
            "state": "RI",
            "postal_code": "029141430",
            "country_code": "US",
            "telephone_number": "401-444-8306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FISHBEIN",
        "first_name": "JENNIFER",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-03",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "282857",
            "primary": false
        },
        {
            "code": "2080P0210X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "RI",
            "license": "MD19375",
            "primary": false
        },
        {
            "code": "2080P0210X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "MA",
            "license": "282857",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110161115A",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "55 Lake Ave N",
            "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.