Individual provider Active NPI

Timothy James Tobin, D.P.M.

  • Podiatrist
  • Beverly, MA
National Provider Identifier
1760572234
Registry record updated Apr 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
1930 Issued in MA
Practice address
900 Cummings Ctr
Suite 109U
Beverly, MA 01915-6198
Phone
(978) 927-1911
Fax
(978) 927-1811
NPI assigned
Oct 13, 2006
Last updated
Apr 7, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 7, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 1930 MA Primary
Foot & Ankle Surgery Podiatrist 213ES0103X 1930 MA

Addresses

Primary practice location

900 Cummings Ctr
Suite 109U
Beverly, MA 01915-6198

Mailing address

900 Cummings Ctr
Suite 109U
Beverly, MA 01915-6198
Phone (978) 927-1911

Other identifiers 1

IdentifierTypeStateIssuer
0357928MedicaidMA

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071001000824 MA Practitioner - Podiatry 0941395206 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Temple University School of Podiatric Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beverly Podiatry Inc.Group PAC ID 4880990290, 3 clinicians

Practice addresses (Care Compare)

900 Cummings Ctr
Suite 309V
Beverly, MA 01915-6181
Phone (978) 922-0288

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue31
Removal of skin lesions1-10
Removal of nail tissue345
Removal or shaving of skin growth217

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1930MAMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Beverly Podiatry Inc. CurrentSince Jan 1, 2016 Accepting new patients
Beverly Podiatry, Inc Podiatrist CurrentSince Jan 12, 2012 Accepting new patients

Locations

900 Cummings Ctr
Ste 109U
Beverly, MA 01915
Phone (617) 639-0828

900 Cummings Ctr
Ste 309V
Beverly, MA 01915
Phone (978) 922-0288

Interoperability endpoints

  • Direct secure messaging: tobin.timothy.bevpod@direct.partners.masshiway.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239062400000",
    "number": "1760572234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 CUMMINGS CTR",
            "address_2": "SUITE 109U",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156198",
            "telephone_number": "978-927-1911",
            "fax_number": "978-927-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 CUMMINGS CTR",
            "address_2": "SUITE 109U",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156198",
            "telephone_number": "978-927-1911",
            "fax_number": "978-927-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOBIN",
        "first_name": "TIMOTHY",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2009-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MA",
            "license": "1930",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MA",
            "license": "1930",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0357928",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly, MA

Sources for this page

Verify at the official NPI Registry.