Individual provider Active NPI

Bahareh Ehsaei, MD

  • Internal Medicine Physician
  • Brockton, MA
National Provider Identifier
1922685775
Registry record updated Apr 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
332453 Issued in NY
Practice address
110 Liberty St
Brockton, MA 02301-5674
Phone
(508) 894-0400
Fax
(508) 894-0412
NPI assigned
Mar 26, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 5, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101281893 VA
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 332453 NY Primary

Addresses

Primary practice location

110 Liberty St
Brockton, MA 02301-5674

Mailing address

110 Liberty St
Brockton, MA 02301-5674
Phone (508) 894-0400

Other practice location 1

2015 Grand Concourse
Bronx, NY 10453-4303
Phone (718) 583-7736

Other practice location 2

2601 Ocean Pkwy
Brooklyn, NY 11235-7745
Phone (718) 616-3779

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, NY, MA3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20240911002994 VA Practitioner - Internal Medicine 1254871676 Reassigns benefits to 1 organization
I20241024001998 NY Practitioner - Internal Medicine 1254871676 Reassigns benefits to 3 organizations
I20250228002667 MA Practitioner - Internal Medicine 1254871676 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Signature Healthcare Medical Group IncGroup PAC ID 7719876267, 250 clinicians

Practice addresses (Care Compare)

110 Liberty St
Brockton, MA 02301-5521
Phone (508) 894-0400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
332453NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Essen Medical Associates, PC CurrentSince Aug 20, 2024 Accepting new patients
Signature Healthcare Medical Group Inc Internal Medicine CurrentSince Apr 1, 2025 Accepting new patients
Sentara Medical Group Internal Medicine CurrentSince Aug 1, 2024 Accepting new patients
House Call Medical Services of New York, PLLC Internal Medicine CurrentSince Aug 20, 2024 Accepting new patients
Essen Medical Associates, PC CurrentSince Aug 20, 2024 Accepting new patients
Bronx Medical Practice P.C. Internal Medicine CurrentSince Aug 20, 2024 Accepting new patients

Locations

680 Centre St
Brockton, MA 02302
Phone (508) 941-7400

110 Liberty St
Brockton, MA 02301

2015 Grand Concourse
Bronx, NY 10453
Phone (718) 294-6200

1371 Seabury Ave
Bronx, NY 10461
Phone (718) 294-6200

2505 Grand Ave
Bronx, NY 10468
Phone (718) 295-1400

8989 Union Tpke
Ste A
Glendale, NY 11385
Phone (718) 746-0400

7401 Granby St
Norfolk, VA 23505
Phone (757) 355-9925

850 Kempsville Rd
Ste 200A
Norfolk, VA 23502
Phone (757) 261-5910

850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162

Interoperability endpoints

  • Direct secure messaging: bahareh.ehsaei@direct.signature.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": "1616716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743811200000",
    "number": "1922685775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 LIBERTY ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023015674",
            "telephone_number": "508-894-0400",
            "fax_number": "508-894-0412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 LIBERTY ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023015674",
            "telephone_number": "508-894-0400",
            "fax_number": "508-894-0412"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2015 Grand Concourse",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104534303",
            "country_code": "US",
            "telephone_number": "718-583-7736",
            "fax_number": "718-537-6180",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2601 Ocean Pkwy",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112357745",
            "country_code": "US",
            "telephone_number": "718-616-3779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EHSAEI",
        "first_name": "BAHAREH",
        "name_prefix": "Miss",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-26",
        "last_updated": "2025-04-05",
        "certification_date": "2025-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101281893",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "332453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.