Individual provider Active NPI

Theophilus V. Addo, MD

  • Internal Medicine Physician
  • North Dartmouth, MA
National Provider Identifier
1750479283
Registry record updated Feb 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
216068 Issued in MA
Practice address
300A Faunce Corner Rd
North Dartmouth, MA 02747-1280
Phone
(508) 973-1140
Fax
(508) 973-1145
NPI assigned
Oct 10, 2006
Last updated
Feb 15, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 10713 RI
Internal Medicine Physician 207R00000X 216068 MA Primary

Addresses

Primary practice location

300A Faunce Corner Rd
North Dartmouth, MA 02747-1280

Mailing address

535 Faunce Corner Rd
Dartmouth, MA 02747-1242
Phone (508) 996-3991

Other practice location 1

535 Faunce Corner Rd
Dartmouth, MA 02747-1242
Phone (508) 996-3991

Other identifiers 2

IdentifierTypeStateIssuer
S400361665OtherMAMEDICARE PTAN
110442053AMedicaidMA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address taddo36315@direct.southcoast.org

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
I20050217000146 MA Practitioner - Internal Medicine 1850343955 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1993
Medicare assignment
May accept Medicare assignment
Group practices
Lifespan Physician Group of Massachusetts IncGroup PAC ID 3870020399, 458 clinicians

Practice addresses (Care Compare)

531 Faunce Corner Rd
Dartmouth, MA 02747-1242
Phone (508) 996-3991

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
216068MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group of Massachusetts Inc Internal Medicine CurrentSince Nov 4, 2024 Accepting new patients
Southcoast Physicians Group, Inc. Internal Medicine CurrentSince Mar 20, 2017 Accepting new patients
Steward Medical Group, Inc CurrentSince Apr 4, 2022 Accepting new patients
Steward Medical Group, Inc Internal Medicine CurrentSince Apr 4, 2022 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Mar 20, 2017 Accepting new patients
Giga Med II, LLC Internal Medicine PastSince Aug 19, 2005 Accepting new patients

Locations

200 Mill Rd
Ste 180
Fairhaven, MA 02719
Phone (508) 973-2000

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

851 Middle St
Ste 2100
Fall River, MA 02721
Phone (508) 235-5445

300A Faunce Corner Rd
North Dartmouth, MA 02747
Phone (508) 973-2213

531 Faunce Corner Rd
North Dartmouth, MA 02747
Phone (508) 991-2255

535 Faunce Corner Rd
North Dartmouth, MA 02747
Phone (508) 961-0606

Interoperability endpoints

  • Direct secure messaging: taddo36315@direct.southcoast.org
  • Direct secure messaging: theophilus.addo.1@2017.direct.athenahealth.com

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644883200000",
    "number": "1750479283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 FAUNCE CORNER RD",
            "city": "DARTMOUTH",
            "state": "MA",
            "postal_code": "027471242",
            "telephone_number": "508-996-3991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300A FAUNCE CORNER RD",
            "city": "NORTH DARTMOUTH",
            "state": "MA",
            "postal_code": "027471280",
            "telephone_number": "508-973-1140",
            "fax_number": "508-973-1145"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "535 Faunce Corner Rd",
            "address_purpose": "LOCATION",
            "city": "Dartmouth",
            "state": "MA",
            "postal_code": "027471242",
            "country_code": "US",
            "telephone_number": "508-996-3991",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADDO",
        "first_name": "THEOPHILUS",
        "middle_name": "V.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2022-02-15",
        "certification_date": "2022-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "10713",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "216068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "S400361665",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110442053A",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "taddo36315@direct.southcoast.org",
            "affiliation": "N",
            "endpointDescription": "Southcoast Health Epic Direct Address",
            "address_1": "300A Faunce Corner Rd",
            "city": "North Dartmouth",
            "state": "MA",
            "country_code": "US",
            "postal_code": "027471280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in North Dartmouth, MA

Sources for this page

Verify at the official NPI Registry.