Shawn M Ferullo, M.D.

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

219827 Issued in MA

Practice address

25 Carleton St
Cambridge, MA 02142-1323

Phone

(617) 253-2974

Fax

(617) 253-5512

NPI assigned

Feb 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Specialty

Family Practice

Education

Boston University School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Massachusetts Institute of TechnologyGroup PAC ID 5597658666, 55 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Massachusetts Institute of Technology

  • Multi-Specialty Clinic/Center
  • Cambridge, MA
  • NPI 1346308723
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1962476994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 MASSACHUSETTS AVE",
            "address_2": "MASSACHUSETTS INSTITUTE OF TECHNOLOGY, E23-171",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021394301",
            "telephone_number": "617-253-2974",
            "fax_number": "617-253-5512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 CARLETON ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021421323",
            "telephone_number": "617-253-2974",
            "fax_number": "617-253-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERULLO",
        "first_name": "SHAWN",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "219827",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MA",
            "license": "219827",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2037106",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristen Ferreira, FNP-BC
• Kaitlyn Mae Ferrier, RPH
• Bryan William Ferrigno, MD
• Danielle Ferris, OTR/L
• Ellsworth Fersch
• Lisa A Ferzoco, M.D.
• Karym Elizabeth Fettig
• Diana Marie Fidrocki, MD
• Francesca Tilocca Field, LCSW
• Rita L Field, DC

• Sports Medicine (Family Medicine) Physician in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Sports Medicine (Family Medicine) Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.