Active NPI
Sam Kontrakul, MD
- Surgery Physician
- South Weymouth, MA
National Provider Identifier
1770530321
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 36924
- Practice address
- 55 Fogg Rd
South Weymouth, MA 02190-2432 - Phone
- (781) 340-8000
- NPI assigned
- May 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 36924 | MA | Primary |
Addresses
Primary practice location
55 Fogg Rd
South Weymouth, MA 02190-2432
Mailing address
944 Washington St
Suite One
South Easton, MA 02375-1177
Phone (508) 238-8646
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2034999 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36924 | MA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239321600000",
"number": "1770530321",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "944 WASHINGTON ST",
"address_2": "SUITE ONE",
"city": "SOUTH EASTON",
"state": "MA",
"postal_code": "023751177",
"telephone_number": "508-238-8646",
"fax_number": "508-230-9772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 FOGG RD",
"city": "SOUTH WEYMOUTH",
"state": "MA",
"postal_code": "021902432",
"telephone_number": "781-340-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KONTRAKUL",
"first_name": "SAM",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-28",
"last_updated": "2009-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MA",
"license": "36924",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2034999",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Weymouth, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.