NPIMap

Organization Active NPI

Woburn Nephrology Associates PC

  • Nephrology Physician
  • Woburn, MA
National Provider Identifier
1750421673
Registry record updated Feb 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
WOBURN NEPHROLOGY ASSOCIATES PC
Practice address
23 Warren Ave
Suite 150
Woburn, MA 01801
Phone
(781) 933-0710
Fax
(781) 937-3947
NPI assigned
Feb 8, 2007
Last updated
Feb 13, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2013

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

Authorized official

Name
Dr. Michele A Crage, MDNPI 1710960190
Title
Partner in Organization
Phone
(781) 933-0710

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X Primary

Addresses

Primary practice location

23 Warren Ave
Suite 150
Woburn, MA 01801

Mailing address

23 Warren Ave
Suite 150
Woburn, MA 01801
Phone (781) 933-0710

Other identifiers 2

IdentifierTypeStateIssuer
M18118OtherMABLUE CROSS BLUE SHIELD
695131OtherMATUFTS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050614001175 MA Part B Supplier - Clinic/Group Practice 8820032485 Receives reassigned benefits from 6 practitioners
Practice locations: Dover, MA; Stoneham, MA; Winchester, MA

National Provider Directory

National Provider Directory
Tax ID family
Woburn Nephrology Associates PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

23 Warren Ave
Ste 150
Woburn, MA 01801
Phone (781) 933-0710

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360713600000",
    "number": "1750421673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 WARREN AVE",
            "address_2": "SUITE 150",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "01801",
            "telephone_number": "781-933-0710",
            "fax_number": "781-937-3947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 WARREN AVE",
            "address_2": "SUITE 150",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "01801",
            "telephone_number": "781-933-0710",
            "fax_number": "781-937-3947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOBURN NEPHROLOGY ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2013-02-13",
        "status": "A",
        "authorized_official_last_name": "CRAGE",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PARTNER IN ORGANIZATION",
        "authorized_official_telephone_number": "781-933-0710",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "M18118",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "695131",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woburn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.