Active NPI
John N Renneburg Jr., MD
- Allergy & Immunology Physician
- Dedham, MA
National Provider Identifier
1861466716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy & Immunology Physician
- License
- 70756
- Practice address
- 1 Lyons St
Dedham, MA 02026-5599 - Phone
- (781) 329-1400
- Fax
- (781) 461-8691
- NPI assigned
- Feb 16, 2006
- 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 |
|---|---|---|---|---|
| Allergy & Immunology Physician | 207K00000X | 70756 | MA | Primary |
Addresses
Primary practice location
1 Lyons St
Dedham, MA 02026-5599
Mailing address
1 Lyons St
Dedham, MA 02026-5599
Phone (781) 329-1400
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5930251 | Other | AETNA US HEALTHCARE | |
| J13537 | Other | BLUE SHIELD HMO BLUE | |
| 3100588 | Other | MEDICAID WELFARE | |
| 784075 | Other | MVP HEALTH CARE | |
| 919279 | Other | FIRST HEALTH | |
| AA2169 | Other | HARVARD PILGRIM HEALTHCAR | |
| 27197 | Other | HEALTHY START | |
| J13537 | Other | BLUE CARE ELECT | |
| J13537 | Other | MEDICARE B | |
| 3100588 | Medicaid | MA | |
| 9900291 | Other | FALLON COMMUNITY HEALTH P | |
| J13537 | Other | BLUE SHIELD INDEMNITY | |
| 0200021 | Other | EVERCARE | |
| 7107816 | Other | CIGNA HEALTH PLAN | |
| 27197 | Other | CHILDRENS MEDICAL SECURIT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 70756 | MA | MD | Allergy & Immunology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reliant Medical Group, Inc | Past | Accepting new patients | |
| Reliant Medical Group, Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
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-
- Family Medicine Physician
- Worcester, MA
- NPI 1720017528
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861466716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 LYONS ST",
"city": "DEDHAM",
"state": "MA",
"postal_code": "020265599",
"telephone_number": "781-329-1400",
"fax_number": "781-461-8691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 LYONS ST",
"city": "DEDHAM",
"state": "MA",
"postal_code": "020265599",
"telephone_number": "781-329-1400",
"fax_number": "781-461-8691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENNEBURG",
"first_name": "JOHN",
"middle_name": "N",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "MA",
"license": "70756",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA US HEALTHCARE",
"identifier": "5930251",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD HMO BLUE",
"identifier": "J13537",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID WELFARE",
"identifier": "3100588",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP HEALTH CARE",
"identifier": "784075",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "919279",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM HEALTHCAR",
"identifier": "AA2169",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHY START",
"identifier": "27197",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE ELECT",
"identifier": "J13537",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE B",
"identifier": "J13537",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3100588",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FALLON COMMUNITY HEALTH P",
"identifier": "9900291",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD INDEMNITY",
"identifier": "J13537",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EVERCARE",
"identifier": "0200021",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA HEALTH PLAN",
"identifier": "7107816",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHILDRENS MEDICAL SECURIT",
"identifier": "27197",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Dedham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.