Michael Dean Medlock, MD

Primary specialty

Addiction Medicine (Preventive Medicine) PhysicianTaxonomy code 2083A0300X

License

79690 Issued in MA

Practice address

47 Congress St
Salem, MA 01970

Phone

(978) 744-8388

NPI assigned

Nov 7, 2005

Last updated

Nov 18, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

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

Specialty

Neurosurgery

Education

University of Florida College of Medicine, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Congenial Healthcare LLCGroup PAC ID 5395011522, 12 clinicians

Middleton Family Medicine Urgent Care LLCGroup PAC ID 0042533218, 74 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: michael.medlock.1@9808.direct.athenahealth.com

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.

• Congenial Healthcare, LLC

  • Internal Medicine Physician
  • Peabody, MA
  • NPI 1730608720
  Medicare reassignment Care Compare group NPD
• Middleton Family Medicine Urgent Care, LLC

  • Clinic/Center
  • Middleton, MA
  • NPI 1902215106
  Medicare reassignment Care Compare group NPD
• Congenial Healthcare, LLC

  dba Middleton Family Medicine Associates

  • Family Medicine Physician
  • Middleton, MA
  • NPI 1063923399
  NPD
• Congenial Healthcare, LLC

  • Internal Medicine Physician
  • Peabody, MA
  • NPI 1790241735
  NPD

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668729600000",
    "number": "1902887185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 TURNING MILL RD",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024201319",
            "telephone_number": "617-833-8928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 CONGRESS ST",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "01970",
            "telephone_number": "978-744-8388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4 Centennial Dr",
            "address_2": "North Shore Neurosurgery and Spine",
            "address_purpose": "LOCATION",
            "city": "Peabody",
            "state": "MA",
            "postal_code": "019607935",
            "country_code": "US",
            "telephone_number": "978-977-0586",
            "fax_number": "978-977-0905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDLOCK",
        "first_name": "MICHAEL",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "MA",
            "license": "79690",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "79690",
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "MA",
            "license": "79690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11000546A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Patrick McQueeney
• Maryann McQueston, RN CFNP
• Barbara Anne Meader
• Peter Meaney
• Stephen Medina Jr., LMHC
• Medpro Home Care Solutions, LLC
• Laura Meese
• Tarsi Paola Melenciano Lara
• Emilie Ann Gervais Mellal, MA, INTERN
• Brianna Shannon Melson, N.P.

• Addiction Medicine (Preventive Medicine) Physician in Salem, MA
• Providers in Salem, MA by specialty
• Addiction Medicine (Preventive Medicine) Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.