Active NPI
Matthew R Fickie, MD
- Internal Medicine Physician
- Waltham, MA
National Provider Identifier
1891897757
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 231500
- Practice address
- 355 Waverley Oaks Rd
Suite 200
Waltham, MA 02452-8474 - Phone
- (781) 647-6920
- Fax
- (781) 891-0056
- NPI assigned
- Sep 2, 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 231500 | MA | |
| Clinical Genetics (M.D.) Physician | 207SG0201X | 231500 | MA | |
| Internal Medicine Physician | 207R00000X | 231500 | MA | Primary |
Addresses
Primary practice location
355 Waverley Oaks Rd
Suite 200
Waltham, MA 02452-8474
Mailing address
355 Waverley Oaks Rd
Suite 200
Waltham, MA 02452-8474
Phone (781) 647-6920
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 |
|---|---|---|---|
| 231500 | MA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Baystate Medical Practices, Inc | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medical Services (Emergency Medicine) Physician
- Springfield, MA
- NPI 1548205909
Internal Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366243200000",
"number": "1891897757",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "355 WAVERLEY OAKS RD",
"address_2": "SUITE 200",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024528474",
"telephone_number": "781-647-6920",
"fax_number": "781-891-0056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "355 WAVERLEY OAKS RD",
"address_2": "SUITE 200",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024528474",
"telephone_number": "781-647-6920",
"fax_number": "781-891-0056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FICKIE",
"first_name": "MATTHEW",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-02",
"last_updated": "2013-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MA",
"license": "231500",
"primary": false
},
{
"code": "207SG0201X",
"taxonomy_group": "",
"desc": "Medical Genetics, Clinical Genetics (M.D.)",
"state": "MA",
"license": "231500",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "231500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.