Basic Information
Provider Information | |||||||||
NPI: | 1346227865 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NORTH SUBURBAN HOSPITALISTS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 9132 | ||||||||
Address2: |   | ||||||||
City: | BROOKLINE | ||||||||
State: | MA | ||||||||
PostalCode: | 024469132 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8009270002 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 85 HERRICK ST | ||||||||
Address2: |   | ||||||||
City: | BEVERLY | ||||||||
State: | MA | ||||||||
PostalCode: | 019151776 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9789223000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/27/2005 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | NEUMAN | ||||||||
AuthorizedOfficialFirstName: | RONALD | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 8009270002 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X |   | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | CJ5152 | 01 | MA | RAILROAD MEDICARE | OTHER | 9709100 | 05 | MA |   | MEDICAID | 64648 | 01 | MA | FALLON | OTHER | 154279XX | 01 | MA | PREFERRED HEALTH | OTHER | 971566 | 01 | MA | NETWORK HEALTH | OTHER | 0024983 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 690390 | 01 | MA | TUFTS HEALTH PLAN | OTHER | M17896 | 01 | MA | BCBS MA | OTHER |