NPIMap

Individual provider Active NPI

Jeremy Goverman, MD

  • Surgical Critical Care Physician
  • Boston, MA
National Provider Identifier
1902896087
Registry record updated Apr 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
223980 Issued in MA
Practice address
55 Fruit St
Gray Bigelow 1302
Boston, MA 02114-2696
Phone
(617) 726-3712
Fax
(617) 367-8936
NPI assigned
Oct 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 223980 MA
Surgery Physician 208600000X 223980 MA
Surgical Critical Care Physician 2086S0102X 223980 MA Primary

Addresses

Primary practice location

55 Fruit St
Gray Bigelow 1302
Boston, MA 02114-2696

Mailing address

PO Box 9142
Charlestown, MA 02129-9142
Phone (617) 726-3712

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
I20060713000290 MA Practitioner - General SurgeryPractitioner - Plastic and Reconstructive SurgeryPractitioner - Critical Care (Intensivists)Practitioner - Other (Physician) 2365455417 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Critical Care (Intensivists)
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision35
Removal of tissue114
Removal of skin lesions11
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
223980MAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
General Hospital Corp Current Accepting new patients
Massachusetts General Physicians Organization Inc Surgery CurrentSince Aug 1, 2009 Accepting new patients
The General Hospital Corporation CurrentSince Oct 21, 2010 Accepting new patients
The Shriners' Hospital for Children Plastic Surgery CurrentSince Mar 18, 2020 Accepting new patients
The Shriners' Hospital for Children Current Accepting new patients
The Shriners' Hospital for Children CurrentSince Mar 18, 2020 Accepting new patients

Locations

55 Fruit St
#1302
Boston, MA 02114
Phone (617) 726-3184

55 Fruit St
#13
Boston, MA 02114
Phone (617) 724-8743

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

516 Carew St
Springfield, MA 01104
Phone (413) 787-2000

Interoperability endpoints

  • Direct secure messaging: goverman.jeremy.mgh@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 3

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": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429747200000",
    "number": "1902896087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9142",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021299142",
            "telephone_number": "617-726-3712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "address_2": "GRAY BIGELOW 1302",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142696",
            "telephone_number": "617-726-3712",
            "fax_number": "617-367-8936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOVERMAN",
        "first_name": "JEREMY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-28",
        "last_updated": "2015-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MA",
            "license": "223980",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "223980",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "MA",
            "license": "223980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.