NPIMap

Individual provider Active NPI

Edward Bahng, M.D.

  • Family Medicine Physician
  • Beverly, MA
National Provider Identifier
1790165546
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
277197 Issued in MA
Practice address
77 Herrick St Ste 101
Beverly, MA 01915-2734
Phone
(978) 927-4110
NPI assigned
Jun 8, 2015
Last updated
Aug 22, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0116027984 VA
Family Medicine Physician 207Q00000X 277197 MA Primary

Addresses

Primary practice location

77 Herrick St Ste 101
Beverly, MA 01915-2734

Mailing address

77 Herrick St Ste 101
Beverly, MA 01915-2734
Phone (978) 927-4110

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
I20181226002111 MA Practitioner - Family Practice 7911242730 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Atrius Health IncGroup PAC ID 4789588641, 1,214 clinicians

Practice addresses (Care Compare)

133 Brookline Ave
Boston, MA 02215-3904
Phone (617) 421-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0116027984VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Atrius Health, Inc. CurrentSince Jan 15, 2019 Accepting new patients
Atrius Health, Inc. CurrentSince Jan 15, 2019 Accepting new patients
Atrius Health, Inc. Past Accepting new patients

Locations

77 Herrick St
Ste 101
Beverly, MA 01915
Phone (978) 232-7115

133 Brookline Ave
Boston, MA 02215
Phone (617) 421-1000

147 Milk St
Fl 9
Boston, MA 02109
Phone (617) 559-8051

Interoperability endpoints

  • Direct secure messaging: ebahngmd281990@direct.atrius.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 8

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": "1433721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1790165546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 HERRICK ST STE 101",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019152734",
            "telephone_number": "978-927-4110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 HERRICK ST STE 101",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019152734",
            "telephone_number": "978-927-4110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAHNG",
        "first_name": "EDWARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-08",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0116027984",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "277197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly, MA

Sources for this page

Verify at the official NPI Registry.