Individual provider Active NPI

Gautam George, M.D.

  • Pulmonary Disease Physician
  • Cambridge, MA
National Provider Identifier
1912252032
Registry record updated Sep 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
MD465143 Issued in PA
Practice address
330 Mount Auburn St
Cambridge, MA 02138-5502
Phone
(617) 499-5160
Fax
(617) 499-5593
NPI assigned
Jul 14, 2012
Last updated
Sep 4, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD465143 PA
Internal Medicine Physician 207R00000X 251828 MA
Critical Care Medicine (Internal Medicine) Physician 207RC0200X MD465143 PA
Pulmonary Disease Physician 207RP1001X MD465143 PA Primary

Addresses

Primary practice location

330 Mount Auburn St
Cambridge, MA 02138-5502

Mailing address

834 Walnut St 650
Philadelphia, PA 19107-5109
Phone (215) 955-5161

Other practice location 1

834 Walnut St 650
Philadelphia, PA 19107
Phone (215) 955-5161

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20180907001003 PA Practitioner - Pulmonary Disease 7315243490 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

834 Chestnut St
Philadelphia, PA 19107-5126
Phone (215) 955-6776

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
251828MAMDInternal Medicine Physician
MD465143PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians Internal Medicine CurrentSince Aug 1, 2018 Accepting new patients
Jefferson University Physicians Past Accepting new patients
Thomas Jefferson University Hospitals Inc Past Accepting new patients

Locations

834 Chestnut St
Ste 420
Philadelphia, PA 19107
Phone (215) 955-6692

834 Walnut St
Ste 650
Philadelphia, PA 19107
Phone (215) 928-7000

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

Organizations & group practices 3

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": "1342224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567555200000",
    "number": "1912252032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "834 WALNUT ST 650",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075109",
            "telephone_number": "215-955-5161",
            "fax_number": "215-955-6003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 MOUNT AUBURN ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021385502",
            "telephone_number": "617-499-5160",
            "fax_number": "617-499-5593"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "834 WALNUT ST 650",
            "address_purpose": "LOCATION",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19107",
            "country_code": "US",
            "telephone_number": "215-955-5161",
            "fax_number": "215-955-6003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GEORGE",
        "first_name": "GAUTAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-14",
        "last_updated": "2019-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD465143",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "251828",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "PA",
            "license": "MD465143",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "PA",
            "license": "MD465143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cambridge, MA

Sources for this page

Verify at the official NPI Registry.