Individual provider Active NPI

Lisa K. Gruber, M.D.

  • Pediatrics Physician
  • Haverhill, MA
National Provider Identifier
1942291679
Registry record updated Feb 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
208195 Issued in MA
Practice address
1 Park Way
Haverhill, MA 01830-6278
Phone
(978) 521-3230
Fax
(978) 521-3256
NPI assigned
Nov 2, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 208195 MA Primary

Addresses

Primary practice location

1 Park Way
Haverhill, MA 01830-6278

Mailing address

1 Parkway
Haverhill, MA 01830-6278
Phone (978) 521-3230

Other identifiers 1

IdentifierTypeStateIssuer
110002162AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20151015002113 MA Practitioner - Pediatric Medicine 8224347158 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mass General Brigham Community Physicians Inc. Pediatrics CurrentSince Feb 1, 2019 Accepting new patients
Steward Medical Group, Inc CurrentSince Jun 25, 2015 Accepting new patients
Mass General Brigham Community Physicians Inc CurrentSince Feb 1, 2019 Accepting new patients
Steward Medical Group, Inc CurrentSince Jun 25, 2015 Accepting new patients
Steward Medical Group Inc. Past Accepting new patients

Locations

77 Warren St
Brighton, MA 02135
Phone (617) 254-1271

11 Nevins St
Ste 201
Brighton, MA 02135
Phone (617) 789-2442

1 Parkway
Haverhill, MA 01830
Phone (978) 521-3210

100 Amesbury St
Ste 103
Lawrence, MA 01840
Phone (978) 683-0157

500 Merrimack St
Lawrence, MA 01843
Phone (978) 557-8800

170 Governors Ave
Medford, MA 02155
Phone (781) 306-6000

Organizations & group practices 5

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550275200000",
    "number": "1942291679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PARKWAY",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "018306278",
            "telephone_number": "978-521-3230",
            "fax_number": "978-521-3256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PARK WAY",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "018306278",
            "telephone_number": "978-521-3230",
            "fax_number": "978-521-3256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUBER",
        "first_name": "LISA",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2019-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "208195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110002162A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Haverhill, MA

Sources for this page

Verify at the official NPI Registry.