NPIMap

Organization Active NPI

Melrose Wakefield Emergency Physicians, Inc.

  • Emergency Medicine Physician
  • Melrose, MA
National Provider Identifier
1790730539
Registry record updated Feb 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
MELROSE WAKEFIELD EMERGENCY PHYSICIANS, INC.
Practice address
585 Lebanon St
Melrose, MA 02176-3225
Phone
(781) 280-1736
NPI assigned
May 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2012

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

Authorized official

Name
Elijah Berg, MD
Title
President
Phone
(781) 280-1500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

585 Lebanon St
Melrose, MA 02176-3225

Mailing address

8 Oak Park Dr
Bedford, MA 01730-1414
Phone (781) 280-1736

Other identifiers 2

IdentifierTypeStateIssuer
9785205MedicaidMA
M17231OtherMABCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031107000277 MA Part B Supplier - Clinic/Group Practice 0244143006 Receives reassigned benefits from 64 practitioners
Practice locations: Medford, MA; Melrose, MA

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 96

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 96

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328140800000",
    "number": "1790730539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 OAK PARK DR",
            "city": "BEDFORD",
            "state": "MA",
            "postal_code": "017301414",
            "telephone_number": "781-280-1736",
            "fax_number": "781-276-6404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "585 LEBANON ST",
            "city": "MELROSE",
            "state": "MA",
            "postal_code": "021763225",
            "telephone_number": "781-280-1736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELROSE WAKEFIELD EMERGENCY PHYSICIANS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2012-02-02",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "ELIJAH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-280-1500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9785205",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "M17231",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melrose, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2012; 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.