NPIMap

Individual provider Active NPI

Michael Iannamorelli, D.O.

  • Surgical Critical Care Physician
  • Worcester, MA
National Provider Identifier
1922454859
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
287397 Issued in MA
Practice address
55 Lake Ave N
Worcester, MA 01655-0002
Phone
(774) 475-0831
Fax
(508) 856-4224
NPI assigned
May 10, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 266760 MA
Surgery Physician 208600000X OS022075 PA
Surgical Critical Care Physician 2086S0102X OS022075 PA
Trauma Surgery Physician 2086S0127X 287397 MA
Surgical Critical Care Physician 2086S0102X 287397 MA Primary

Addresses

Primary practice location

55 Lake Ave N
Worcester, MA 01655-0002

Mailing address

PO Box 415348
Boston, MA 02241-5348

Other practice location 1

1000 E Mountain Dr
Wilkes Barre, PA 18711-0027
Phone (570) 808-2340

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, MA2 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
I20220902002364 PA Practitioner - General Surgery 9436553302 Reassigns benefits to 1 organization
I20240130001072 MA Practitioner - General Surgery 9436553302 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Lake Erie College of Osteopathic Medicine, Erie, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Umass Memorial Medical Group IncGroup PAC ID 4284539891, 2,494 clinicians

Practice addresses (Care Compare)

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

Hospital & facility affiliations

  • Umass Memorial Medical Center/University Campus Hospital, Worcester, MA, CCN 220163
  • Umass Memorial Healthalliance Hospitals Hospital, Leominster, MA, CCN 220001
  • Umass Memorial Health - Harrington Hospital Hospital, Southbridge, MA, CCN 220019
  • Milford Regional Medical Center Hospital, Milford, MA, CCN 220090
  • Marlborough Hospital Hospital, Marlborough, MA, CCN 220049

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
266760MAMDSurgery Physician
OS022075PAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic CurrentSince Sep 1, 2022 Accepting new patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Sep 1, 2022 Accepting new patients
Umass Memorial Medical Group Inc Surgery CurrentSince Jan 29, 2024 Accepting new patients
Umass Memorial Medical Group, Inc. CurrentSince Jan 29, 2024 Accepting new patients
Umass Memorial Medical Center, Inc. Past Accepting new patients
Geisinger Clinic Past Accepting new patients

Locations

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

100 N Academy Ave
Danville, PA 17822

25 Church St
Wilkes Barre, PA 18702
Phone (570) 340-5800

1000 E Mountain Dr
Wilkes Barre, PA 18711
Phone (570) 826-7300

1000 E Mountain Blvd
Wilkes Barre, PA 18711
Phone (570) 808-7399

Organizations & group practices 7

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 6

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": "1462838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1922454859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAKE AVE N",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016550002",
            "telephone_number": "774-475-0831",
            "fax_number": "508-856-4224"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 E Mountain Dr",
            "address_purpose": "LOCATION",
            "city": "Wilkes Barre",
            "state": "PA",
            "postal_code": "187110027",
            "country_code": "US",
            "telephone_number": "570-808-2340",
            "fax_number": "570-808-7904",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IANNAMORELLI",
        "first_name": "MICHAEL",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-10",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "266760",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "OS022075",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "PA",
            "license": "OS022075",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "MA",
            "license": "287397",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "MA",
            "license": "287397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.