Individual provider Active NPI

Robert J. Terlato, M.D.

  • Cardiovascular Disease Physician
  • Gardner, MA
National Provider Identifier
1790776730
Registry record updated Apr 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
73621 Issued in MA
Practice address
250 Green St
Suite 110
Gardner, MA 01440-1396
Phone
(978) 630-5020
Fax
(978) 630-5029
NPI assigned
Oct 31, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 73621 MA
Cardiovascular Disease Physician 207RC0000X 73621 MA Primary

Addresses

Primary practice location

250 Green St
Suite 110
Gardner, MA 01440-1396

Mailing address

250 Green St
Suite 110
Gardner, MA 01440-1396
Phone (978) 630-5020

Other identifiers 1

IdentifierTypeStateIssuer
3079830MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050415000098 MA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 0143267674 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
73621MAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Heywood Memorial Hospital CurrentSince Jun 6, 1991 Accepting new patients
Athol Memorial Hospital Incorporated Cardiovascular Disease CurrentSince Oct 15, 2012 Accepting new patients
Heywood Medical Group Inc. Internal Medicine CurrentSince Jun 6, 1991 Accepting new patients
Henry Heywood Memorial Hospital Cardiovascular Disease CurrentSince Jun 6, 1991 Accepting new patients
Heywood Affiliated Medical Group Inc. CurrentSince Jun 6, 1991 Accepting new patients
Regional Home Care Inc. CurrentSince Aug 22, 2008 Accepting new patients

Locations

2033 Main St
Athol, MA 01331
Phone (978) 249-1295

242 Green St
Gardner, MA 01440
Phone (978) 258-4734

250 Green St
Gardner, MA 01440
Phone (978) 630-5050

250 Green St
Ste 110
Gardner, MA 01440
Phone (978) 630-5030

Organizations & group practices 6

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.

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": "1303430400000",
    "number": "1790776730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 GREEN ST",
            "address_2": "SUITE 110",
            "city": "GARDNER",
            "state": "MA",
            "postal_code": "014401396",
            "telephone_number": "978-630-5020",
            "fax_number": "978-630-5029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 GREEN ST",
            "address_2": "SUITE 110",
            "city": "GARDNER",
            "state": "MA",
            "postal_code": "014401396",
            "telephone_number": "978-630-5020",
            "fax_number": "978-630-5029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERLATO",
        "first_name": "ROBERT",
        "middle_name": "J.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2011-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "73621",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MA",
            "license": "73621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3079830",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardner, MA

Sources for this page

Verify at the official NPI Registry.