NPIMap

Organization Active NPI

Davis Square Family Practice

  • Family Medicine Physician
  • Somerville, MA
National Provider Identifier
1780782409
Registry record updated Nov 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DAVIS SQUARE FAMILY PRACTICE
Practice address
260 Elm St
Suite 105
Somerville, MA 02144-2951
Phone
(617) 666-9577
Fax
(617) 666-3190
NPI assigned
Sep 20, 2006
Last updated
Nov 10, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2011

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

Authorized official

Name
Dr. Deborah Bershel, MDNPI 1437257227
Title
Owner
Phone
(617) 666-9577

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
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

260 Elm St
Suite 105
Somerville, MA 02144-2951

Mailing address

260 Elm St
Suite 105
Somerville, MA 02144-2951
Phone (617) 666-9577

Other identifiers 4

IdentifierTypeStateIssuer
694934OtherMATUFTS HEALTH PLAN
80946OtherMAFALLON
9722131MedicaidMA
M18036OtherMABCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050614000069 MA Part B Supplier - Clinic/Group Practice 1355385196 Receives reassigned benefits from 7 practitioners
Practice locations: Somerville, MA

National Provider Directory

National Provider Directory

Locations

255 Elm St
Ste 301
Somerville, MA 02144
Phone (617) 666-9577

260 Elm St
Somerville, MA 02144
Phone (617) 666-9577

260 Elm St
Ste 105
Somerville, MA 02144
Phone (617) 571-2082

Practitioners & affiliated clinicians

Practitioners 12

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": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320883200000",
    "number": "1780782409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 ELM ST",
            "address_2": "SUITE 105",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021442951",
            "telephone_number": "617-666-9577",
            "fax_number": "617-666-3190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 ELM ST",
            "address_2": "SUITE 105",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021442951",
            "telephone_number": "617-666-9577",
            "fax_number": "617-666-3190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIS SQUARE FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2011-11-10",
        "status": "A",
        "authorized_official_last_name": "BERSHEL",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-666-9577",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "694934",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON",
            "identifier": "80946",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9722131",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "M18036",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerville, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2011; 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.