NPIMap

Individual provider Active NPI

Deep S Phachu, M.D.

  • Nephrology Physician
  • Worcester, MA
National Provider Identifier
1912435736
Registry record updated Feb 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
290738 Issued in MA
Practice address
123 Summer St Ste 685N
Worcester, MA 01608-1216
Phone
(508) 363-6008
NPI assigned
May 24, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 290738 MA Primary
Nephrology Physician 207RN0300X 064396 CT

Addresses

Primary practice location

123 Summer St Ste 685N
Worcester, MA 01608-1216

Mailing address

123 Summer St Ste 685N
Worcester, MA 01608-1216
Phone (508) 363-6008

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, CT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220803001246 MA Practitioner - Nephrology 3779856265 Reassigns benefits to 1 organization
I20230224001068 CT Practitioner - Nephrology 3779856265 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Mass NephrologyGroup PAC ID 2466834742, 4 clinicians

Practice addresses (Care Compare)

123 Summer St
685N
Worcester, MA 01608-1216
Phone (508) 363-6008

320 Pomfret St
Putnam, CT 06260-1836
Phone (508) 363-6008

Hospital & facility affiliations

  • ARA Auburn Dialysis Center Dialysis facility, Auburn, MA, CCN 222593
  • FMC - Freedom Center of Worcester Dialysis facility, Worcester, MA, CCN 222590
  • St Vincent Hospital Hospital, Worcester, MA, CCN 220176
  • Umass Memorial Health - Harrington Hospital Hospital, Southbridge, MA, CCN 220019
  • Day Kimball Hospital Hospital, Putnam, CT, CCN 070003
  • Umass Memorial Healthalliance Hospitals Hospital, Leominster, MA, CCN 220001
  • Umass Memorial Medical Center/University Campus Hospital, Worcester, MA, CCN 220163

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
064396CTMDNephrology Physician
290738MAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Mass Nephrology Nephrology CurrentSince Jul 1, 2022 Accepting new patients
Renal and Transplant Associates of New England PC Nephrology PastSince Aug 1, 2022 Accepting new patients

Locations

320 Pomfret St
Putnam, CT 06260
Phone (860) 963-6331

346 Pomfret St
Putnam, CT 06260
Phone (860) 928-0815

100 South St
Ste 208
Southbridge, MA 01550
Phone (508) 764-6356

123 Summer St
Ste 685N
Worcester, MA 01608
Phone (508) 363-6008

123 Summer St
#685N
Worcester, MA 01608
Phone (508) 363-6008

123 Summer St
Ste 685
Worcester, MA 01608
Phone (508) 363-6008

123 Summer St
Worcester, MA 01608
Phone (508) 363-6000

Organizations & group practices 2

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 9

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": "1495584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675382400000",
    "number": "1912435736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 SUMMER ST STE 685N",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016081216",
            "telephone_number": "508-363-6008",
            "fax_number": "508-363-7164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 SUMMER ST STE 685N",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016081216",
            "telephone_number": "508-363-6008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHACHU",
        "first_name": "DEEP",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-24",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MA",
            "license": "290738",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CT",
            "license": "064396",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.