Active NPI
Thomas L. Fazio, M.D.
- Gastroenterology Physician
- Lawrence, MA
National Provider Identifier
1902800832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 42754
- Practice address
- 500 Merrimack St
Riverwalk
Lawrence, MA 01843-1756 - Phone
- (978) 557-8700
- Fax
- (978) 557-8867
- NPI assigned
- Jun 9, 2005
- 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 |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 42754 | MA | Primary |
Addresses
Primary practice location
500 Merrimack St
Riverwalk
Lawrence, MA 01843-1756
Mailing address
500 Merrimack St
Riverwalk
Lawrence, MA 01843-1756
Phone (978) 557-8700
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3925416 | Other | CIGNA HEALTHCARE | |
| 100014711 | Other | RAILROAD MEDICARE | |
| 0011277 | Other | NEIGHBORHOOD HEALTH PLAN | |
| 678816 | Other | HEALTHSOURCE | |
| D11110 | Other | MA | BLUE CROSS BLUE SHIELD |
| 30201837 | Other | NH MEDICAID | |
| 975010 | Other | NETWORK HEALTH | |
| A54061 | Other | NH | ANTHEM BLUE CROSS |
| 042754 | Other | MA | TUFTS HEALTH PLAN |
| 1902800832 | Other | MA | FALLON COMMUNITY HEALTH PLAN |
| 2060949 | Medicaid | MA | |
| 29-00569 | Other | EVERCARE | |
| 4035145 | Other | MA | AETNA NON HMO |
| 1902800832 | Other | MA | AETNA HMO |
| 30259 | Other | MA | HARVARD PILGRIM HEALTH CA |
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 |
|---|---|---|---|
| 42754 | MA | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383004800000",
"number": "1902800832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 MERRIMACK ST",
"address_2": "RIVERWALK",
"city": "LAWRENCE",
"state": "MA",
"postal_code": "018431756",
"telephone_number": "978-557-8700",
"fax_number": "978-557-8867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 MERRIMACK ST",
"address_2": "RIVERWALK",
"city": "LAWRENCE",
"state": "MA",
"postal_code": "018431756",
"telephone_number": "978-557-8700",
"fax_number": "978-557-8867"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAZIO",
"first_name": "THOMAS",
"middle_name": "L.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-09",
"last_updated": "2013-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "MA",
"license": "42754",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA HEALTHCARE",
"identifier": "3925416",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "100014711",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEIGHBORHOOD HEALTH PLAN",
"identifier": "0011277",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHSOURCE",
"identifier": "678816",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "D11110",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NH MEDICAID",
"identifier": "30201837",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NETWORK HEALTH",
"identifier": "975010",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS",
"identifier": "A54061",
"state": "NH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "042754",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FALLON COMMUNITY HEALTH PLAN",
"identifier": "1902800832",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2060949",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EVERCARE",
"identifier": "29-00569",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA NON HMO",
"identifier": "4035145",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "1902800832",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM HEALTH CA",
"identifier": "30259",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lawrence, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.