Unknown Individual – Cardiovascular Disease Physician, NPI 1548216625

Cardiovascular Disease Physician

Unknown Individual is a healthcare provider. based in Beverly, Massachusetts. specializing in Cardiovascular Disease Physician. They hold a License No. 227739 (MA). The NPI Number for Unknown Individual is 1548216625

Main info

Organization

Inactive

31 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1548216625

Phone

(978) 927-4110

Address

77 HERRICK ST

Deactivation Date

20 April 2021

Doctor Profile

Medical School Name

OTHER

Secondary Phone

9789274110

Graduation Year

1995 (31 years ago)

PAC ID

2163527045

Group Practice PAC ID

4789588641

Professional Enrollment ID

I20070423000033

Contacts

Secure Messaging

msheikhmd45149@direct.atrius.masshiway.net

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness85

Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

77, Herrick Street, Beverly, Essex County, Massachusetts, 01915, United States
SUITE 101
BEVERLY, MA 019152782
Phone: (978) 927-4110
Fax: (978) 232-7057
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 01915)

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Provider's Procedures

Unknown Individual performs procedures in Cardiovascular Disease Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
INTERVENTIONAL CARDIOLOGY	MA	85610	Blood test, clotting time	187	26

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 4789588641View full group profile

Name	Specialty	State
DR. ANDREW IRA OBER (M.D.)	-	MA
INJIL ABU BAKAR (MD)	Family Practice	MA
DR. CLARA D COKONIS (M.D.)	D E R M A T O L O G Y	MA
JOHN M CORNWELL (MD)	Emergency Medicine	MA
DANIEL C-S LEE (MD)	Internal Medicine, Cardiovascular Disease (Cardiology)	MA
ALONA ROTKOVITCH (NP)	-	MA
DR. SARAH ELIZABETH INGHAM (M.D.)	O B S T E T R I C S/ G Y N E C O L O G Y	MA
PATRICIA ANTOS LONG	-	MA
AARON BIRNBAUM	Internal Medicine	MA
CECILIA TRAN HURST (M.D.)	O T O L A R Y N G O L O G Y	MA