NPIMap

Individual provider Active NPI

David Mudd, MD

  • Internal Medicine Physician
  • Brockton, MA
National Provider Identifier
1750376794
Registry record updated May 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
73217 Issued in MA
Practice address
1 Pearl St
Suite 1000
Brockton, MA 02301-2864
Phone
(508) 897-6080
Fax
(508) 897-6085
NPI assigned
Sep 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 73217 MA Primary

Addresses

Primary practice location

1 Pearl St
Suite 1000
Brockton, MA 02301-2864

Mailing address

1 Pearl St
Suite 1000
Brockton, MA 02301-2864
Phone (508) 897-6080

Other identifiers 1

IdentifierTypeStateIssuer
3075672MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050413000934 MA Practitioner - Internal Medicine 5890732523 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Tufts University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Revere Medical of Massachusetts PCGroup PAC ID 0749715795, 113 clinicians
Steward Medical Group IncGroup PAC ID 2860688728, 23 clinicians

Practice addresses (Care Compare)

1 Pearl St
Suite 1000
Brockton, MA 02301-2869
Phone (508) 897-6050

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
73217MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Revere Medical of Massachusetts, PC Internal Medicine CurrentSince Oct 30, 2024 Accepting new patients
Steward Medical Group, Inc CurrentSince Dec 1, 2011 Accepting new patients
Steward Medical Group, Inc CurrentSince Dec 1, 2011 Accepting new patients

Locations

11 Nevins St
Ste 201
Brighton, MA 02135
Phone (617) 789-2442

1 Pearl St
Ste 1000
Brockton, MA 02301
Phone (508) 897-6050

235 N Pearl St
Brockton, MA 02301
Phone (508) 427-2525

15 Payson Rd
Ste 3
Foxboro, MA 02035
Phone (508) 772-1438

104 Liberty St
Hanson, MA 02341
Phone (617) 293-5454

62 Brown St
#507
Haverhill, MA 01830
Phone (978) 722-7818

100 Amesbury St
Ste 103
Lawrence, MA 01840
Phone (978) 683-0157

Interoperability endpoints

  • Direct secure messaging: david.mudd.1@32866.direct.athenahealth.com

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 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304294400000",
    "number": "1750376794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PEARL ST",
            "address_2": "SUITE 1000",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023012864",
            "telephone_number": "508-897-6080",
            "fax_number": "508-897-6085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PEARL ST",
            "address_2": "SUITE 1000",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023012864",
            "telephone_number": "508-897-6080",
            "fax_number": "508-897-6085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUDD",
        "first_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-15",
        "last_updated": "2011-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "73217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3075672",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.