Active NPI
Robert Mathieu Solomon, DMD, MMSC
- Periodontics
- Revere, MA
National Provider Identifier
1831249127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 20602
- Practice address
- One Orr Square
Revere, MA 02151 - Phone
- (781) 284-1430
- NPI assigned
- Jan 11, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 20602 | MA | Primary |
Addresses
Primary practice location
One Orr Square
Revere, MA 02151
Mailing address
One Orr Square
Revere, MA 02151
Phone (781) 284-1430
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150610001689 | MA | Order and Referring Only - Other (Physician) | 0042531493 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20602 | MA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447372800000",
"number": "1831249127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "ONE ORR SQUARE",
"city": "REVERE",
"state": "MA",
"postal_code": "02151",
"telephone_number": "781-284-1430"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "ONE ORR SQUARE",
"city": "REVERE",
"state": "MA",
"postal_code": "02151",
"telephone_number": "781-284-1430"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOLOMON",
"first_name": "ROBERT",
"middle_name": "MATHIEU",
"name_prefix": "Dr.",
"credential": "DMD, MMSC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-11",
"last_updated": "2015-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MA",
"license": "20602",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Revere, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.