Individual provider Active NPI

John C Carroll, MD

  • Urology Physician
  • Fall River, MA
National Provider Identifier
1902804990
Registry record updated Apr 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
78526 Issued in MA
Practice address
1601 South Main Street
Fall River, MA 02724-2107
Phone
(508) 678-0004
Fax
(508) 678-6970
NPI assigned
Jul 13, 2005
Last updated
Apr 21, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 78526 MA Primary

Addresses

Primary practice location

1601 South Main Street
Fall River, MA 02724-2107

Mailing address

200 Mill Road
Suite 180
Fairhaven, MA 02719-5252
Phone (508) 973-2000

Other identifiers 1

IdentifierTypeStateIssuer
110058977AMedicaidMA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jcarroll5614@direct.southcoast.org

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050912000885 MA Practitioner - Urology 8123056173 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Tufts University School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southcoast Physicians Group IncGroup PAC ID 0749171957, 875 clinicians

Practice addresses (Care Compare)

534 Prospect St
Fall River, MA 02720-5281
Phone (508) 973-7766

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Knee replacement1-10
Prostate resection43

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Urology Inc Urology CurrentSince Sep 1, 1997 Accepting new patients
Southcoast Hospitals Group, Inc CurrentSince Jan 1, 2014 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Dec 1, 2012 Accepting new patients
Southcoast Hospitals Group Inc CurrentSince Jan 1, 2014 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Dec 1, 2012 Accepting new patients
Southcoast Physicians Group, Inc. Past Accepting new patients

Locations

200 Mill Rd
Ste 180
Fairhaven, MA 02719
Phone (508) 973-2000

1030 President Ave
Fall River, MA 02720
Phone (508) 235-6427

1601 S Main St
Fall River, MA 02724
Phone (508) 678-0004

363 Highland Ave
Fall River, MA 02720
Phone (508) 679-7052

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

874 Purchase St
New Bedford, MA 02740
Phone (508) 992-6553

340 Main St
Ste 670
Worcester, MA 01608
Phone (508) 754-3560

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1121212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587427200000",
    "number": "1902804990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MILL ROAD",
            "address_2": "SUITE 180",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "027195252",
            "telephone_number": "508-973-2000",
            "fax_number": "508-973-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 SOUTH MAIN STREET",
            "city": "FALL RIVER",
            "state": "MA",
            "postal_code": "027242107",
            "telephone_number": "508-678-0004",
            "fax_number": "508-678-6970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "JOHN",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-13",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MA",
            "license": "78526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110058977A",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jcarroll5614@direct.southcoast.org",
            "affiliation": "N",
            "endpointDescription": "Southcoast Health Epic Direct Address",
            "address_1": "1601 South Main Street",
            "city": "Fall River",
            "state": "MA",
            "country_code": "US",
            "postal_code": "027242107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fall River, MA

Sources for this page

Verify at the official NPI Registry.