Individual provider Active NPI

Michael Thomas Nathan, MD

  • Internal Medicine Physician
  • Revere, MA
National Provider Identifier
1821070160
Registry record updated Apr 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
72450 Issued in MA
Practice address
300 Ocean Ave
RHC Revere Healthcare Center
Revere, MA 02151-3675
Phone
(781) 485-6300
Fax
(781) 485-6392
NPI assigned
Nov 14, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2014

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 72450 MA Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 72450 MA

Addresses

Primary practice location

300 Ocean Ave
RHC Revere Healthcare Center
Revere, MA 02151-3675

Mailing address

PO Box 9142
Mass General Physician Organization
Charlestown, MA 02129-9142
Phone (781) 485-6300

Other identifiers 3

IdentifierTypeStateIssuer
072450OtherMATUFTS HEALTH PLAN
3078531MedicaidMA
J11198OtherMABCBS MA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20040623000350 MA Practitioner - Internal MedicinePractitioner - Geriatric Medicine 4385629351 Reassigns benefits to 2 organizations
I20240412000284 TX Practitioner - Internal Medicine 4385629351 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rush Medical College of Rush University, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
72450MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
General Hospital Corp Current Accepting new patients
Rosebud Indian Health Service CurrentSince Jan 29, 2024 Accepting new patients
The General Hospital Corporation CurrentSince Oct 1, 2006 Accepting new patients
Rosebud Indian Health Service CurrentSince Jan 29, 2024 Accepting new patients
Massachusetts General Physicians Organization Inc Internal Medicine CurrentSince Apr 22, 1991 Accepting new patients

Locations

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

300 Ocean Ave
Revere, MA 02151
Phone (781) 485-6000

Interoperability endpoints

  • Direct secure messaging: nathan.michael.mgh@direct.partners.masshiway.net

Organizations & group practices 5

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": "1131926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397606400000",
    "number": "1821070160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9142",
            "address_2": "MASS GENERAL PHYSICIAN ORGANIZATION",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021299142",
            "telephone_number": "781-485-6300",
            "fax_number": "781-485-6392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 OCEAN AVE",
            "address_2": "RHC REVERE HEALTHCARE CENTER",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021513675",
            "telephone_number": "781-485-6300",
            "fax_number": "781-485-6392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NATHAN",
        "first_name": "MICHAEL",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-14",
        "last_updated": "2014-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "72450",
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MA",
            "license": "72450",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "072450",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3078531",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MA",
            "identifier": "J11198",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Revere, MA

Sources for this page

Verify at the official NPI Registry.