Individual provider Active NPI

Michael SD Agus, MD

  • Pediatric Critical Care Medicine Physician
  • Boston, MA
National Provider Identifier
1952382301
Registry record updated Apr 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
157152 Issued in MA
Practice address
300 Longwood Ave
Main 11 South
Boston, MA 02115-5724
Phone
(617) 355-5849
Fax
(888) 883-9238
NPI assigned
Nov 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 157152 MA
Pediatric Critical Care Medicine Physician 2080P0203X 157152 MA Primary
Pediatric Endocrinology Physician 2080P0205X 157152 MA

Addresses

Primary practice location

300 Longwood Ave
Main 11 South
Boston, MA 02115-5724

Mailing address

300 Longwood Ave
Main 11 South
Boston, MA 02115-5724
Phone (617) 355-5849

Other identifiers 3

IdentifierTypeStateIssuer
J19867OtherMABCBS MA
3197239MedicaidMA
157152OtherMATUFTS HEALTH PLAN

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
I20040505001381 MA Practitioner - Critical Care (Intensivists)Practitioner - Pediatric MedicinePractitioner - Endocrinology 4587652623 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Endocrinology
Education
Perelman School of Med at the University of Pennsylvania, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Children'S Hospital Pediatric Associates, IncGroup PAC ID 3476541830, 333 clinicians

Practice addresses (Care Compare)

300 Longwood Ave
Boston, MA 02115-5724
Phone (617) 355-6000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
157152MAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Pediatric Associates, Inc Pediatrics CurrentSince Mar 29, 1999 Accepting new patients
Pratt Pediatric Associates Inc Pediatrics CurrentSince Jan 27, 2024 Accepting new patients
CHMC Anesthesia Foundation Inc Pediatrics CurrentSince Jun 1, 2010 Accepting new patients
Children'S Hospital Corporation Past Accepting new patients
Childrens Hospital Boston Past Accepting new patients

Locations

85 Herrick St
Beverly, MA 01915
Phone (978) 816-3700

300 Longwood Ave
Boston, MA 02115
Phone (617) 355-4956

800 Washington St
Boston, MA 02111
Phone (617) 636-4800

800 Washington St
#1
Boston, MA 02111

55 Fruit St
Boston, MA 02114

300 Longwood Ave
#11S
Boston, MA 02115
Phone (617) 355-5849

Interoperability endpoints

  • Direct secure messaging: magus22041@direct.bostonchildrens.org

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": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397088000000",
    "number": "1952382301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "address_2": "MAIN 11 SOUTH",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155724",
            "telephone_number": "617-355-5849",
            "fax_number": "888-883-9238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "address_2": "MAIN 11 SOUTH",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155724",
            "telephone_number": "617-355-5849",
            "fax_number": "888-883-9238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGUS",
        "first_name": "MICHAEL",
        "middle_name": "SD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2014-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "157152",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "MA",
            "license": "157152",
            "primary": true
        },
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "MA",
            "license": "157152",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MA",
            "identifier": "J19867",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3197239",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "157152",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.