NPIMap

Individual provider Active NPI

Omar Khaled Selim, MD

  • Vascular Surgery Physician
  • Boston, MA
National Provider Identifier
1871212191
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
314130 Issued in NY
Practice address
800 Washington St # 259
Boston, MA 02111-1552
Phone
(647) 624-3401
NPI assigned
Aug 22, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 314130 NY Primary

Addresses

Primary practice location

800 Washington St # 259
Boston, MA 02111-1552

Mailing address

800 Washington St # 259
Boston, MA 02111-1552
Phone (647) 624-3401

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221005002412 MA Practitioner - Vascular Surgery 3375929979 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1153 Centre St
Jamaica Plain, MA 02130-3446
Phone (617) 983-7000

20 Patriot PL
Foxborough, MA 02035-1375
Phone (508) 718-4000

55 Fruit St
Boston, MA 02114-2621
Phone (617) 726-2000

75 Francis St
Boston, MA 02115-6110
Phone (617) 732-5500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)17
Removal of tissue19

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
314130NYMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Brigham and Women's Hospital Current Accepting new patients
Cardiovascular Center at Tufts Medical Center, Inc. CurrentSince Jul 1, 2022 Accepting new patients
Brigham & Womens Physicians Organization Inc CurrentSince Aug 1, 2024 Accepting new patients
LGH Professional Services LLC Past Accepting new patients
Brigham & Womens Hospital, Inc. Past Accepting new patients
Brigham and Womens Physicians Organization Inc Past Accepting new patients

Locations

800 Washington St
#259
Boston, MA 02111
Phone (647) 624-3401

800 Washington St
Boston, MA 02111
Phone (617) 636-4800

75 Francis St
Boston, MA 02115

295 Varnum Ave
Lowell, MA 01854
Phone (978) 788-7344

Interoperability endpoints

  • Direct secure messaging: selim.omar.bwh@direct.partners.masshiway.net

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1661126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1871212191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 WASHINGTON ST # 259",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021111552",
            "telephone_number": "647-624-3401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 WASHINGTON ST # 259",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021111552",
            "telephone_number": "647-624-3401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELIM",
        "first_name": "OMAR",
        "middle_name": "KHALED",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-22",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NY",
            "license": "314130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.