NPIMap

Individual provider Active NPI

John David Mudrock, M.D.

  • Internal Medicine Physician
  • Wakefield, MA
National Provider Identifier
1780675751
Registry record updated Feb 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
44046 Issued in MA
Practice address
888 Main St Ste 101
Wakefield, MA 01880-4080
Phone
(781) 620-4888
Fax
(781) 245-2602
NPI assigned
Oct 31, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 19, 2021

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 44046 MA Primary

Addresses

Primary practice location

888 Main St Ste 101
Wakefield, MA 01880-4080

Mailing address

888 Main St Ste 101
Wakefield, MA 01880-4080
Phone (781) 620-4888

Other identifiers 1

IdentifierTypeStateIssuer
0129704MedicaidMA

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
I20050324000794 MA Practitioner - Internal Medicine 1456307271 Reassigns benefits to 1 organization
Practice locations: Melrose, MA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
George Washington University School of Medicine, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hallmark Health Medical Associates IncGroup PAC ID 4385638782, 151 clinicians

Practice addresses (Care Compare)

888 Main St
Wakefield, MA 01880-4080
Phone (781) 620-4888

Hospital & facility affiliations

  • Tufts Medicine Care at Home Home health agency, Lowell, MA, CCN 227206
  • Pathways Healthcare Home health agency, Westwood, MA, CCN 227569
  • Mass General Brigham Home Care, Inc Home health agency, Newton, MA, CCN 227207
  • Elara Caring Home health agency, Newburyport, MA, CCN 227503
  • All Care Vna-Greater Lynn Inc Home health agency, Lynn, MA, CCN 227263
  • Melrosewakefield Healthcare Hospital, Melrose, MA, CCN 220070
  • Tufts Medical Center Hospital, Boston, MA, CCN 220116
  • Winchester Hospital Hospital, Winchester, MA, CCN 220105
  • Lowell General Hospital Hospital, Lowell, MA, CCN 220063
  • Spaulding Rehabilitation Hospital Inpatient rehabilitation facility, Charlestown, MA, CCN 223034

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hallmark Health Medical Associates Inc Internal Medicine CurrentSince Jan 1, 2017 Accepting new patients

Locations

425 Revere St
Revere, MA 02151
Phone (781) 286-1313

888 Main St
Wakefield, MA 01880
Phone (781) 620-4888

888 Main St
Ste 101
Wakefield, MA 01880
Phone (781) 620-4888

Interoperability endpoints

  • Direct secure messaging: jmudrock28812@tuftsmedicine.direct-ci.com

Organizations & group practices 1

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 11

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": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613692800000",
    "number": "1780675751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 MAIN ST STE 101",
            "city": "WAKEFIELD",
            "state": "MA",
            "postal_code": "018804080",
            "telephone_number": "781-620-4888",
            "fax_number": "781-245-2602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 MAIN ST STE 101",
            "city": "WAKEFIELD",
            "state": "MA",
            "postal_code": "018804080",
            "telephone_number": "781-620-4888",
            "fax_number": "781-245-2602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUDROCK",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "44046",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0129704",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wakefield, MA

Sources for this page

Verify at the official NPI Registry.