PATAN GULTAWATVICHAI (M.D.) – Hematology & Oncology Physician, NPI 1720335987

PATAN GULTAWATVICHAI (M.D.) is a healthcare provider. based in Worcester, Massachusetts. specializing in HEMATOLOGY/ONCOLOGY. They hold the professional credentials M.D.. They hold a License No. MD221300 (OR). The NPI Number for PATAN GULTAWATVICHAI (M.D.) is 1720335987

Main info

Male
18 Years Of Experience
Accepts Medicare Assignment
Name
PATAN GULTAWATVICHAI (M.D.)
NPI
1720335987
Phone
(508) 334-3550
Address
55 Lake Ave N
Enumeration Date
7 August 2012
Last Update Date
27 November 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9713144522
Graduation Year
2008 (18 years ago)
PAC ID
9931348695
Group Practice PAC ID
0648719989
Professional Enrollment ID
I20241002002058
Address ID
OR972236683PO9495XSTXX402

Contacts

Secure Messaging
pgultawatvichai28847@UmassMemorial.direct-ci.com
FHIR Endpoint
https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience64
Completeness85
Years active:13State licenses:2Other namesUpdated within 12 months

606 HEMATOLOGY/ONCOLOGY in MA

Provider Addresses for PATAN GULTAWATVICHAI (M.D.)

  • 55 Lake Ave N

    Worcester, MA 01655

    Phone: (508) 334-3550

    Fax: (774) 442-6715

    Type: Location

  • 2720 Commercial St SE

    Salem, OR 973024495

    Phone: (971) 314-4522

    Fax: (971) 314-4527

    Type: Location

  • 275 Nichols Rd

    Fitchburg, MA 014201919

    Phone: (978) 343-5048

    Type: Location

  • PO BOX 415348

    BOSTON, MA 022415348

    Phone: (800) 225-8885

    Fax: (508) 334-1977

    Type: Mailing

  • 55 LAKE AVE N

    WORCESTER, MA 01655

    Phone: (508) 334-3550

    Fax: (774) 442-6715

    Type: Location

  • 5 NEPONSET ST

    WORCESTER, MA 016062714

    Phone:

    Type: Mailing

  • 9495 SW LOCUST ST STE G

    PORTLAND, OR 972236683

    Phone: (971) 314-4522

    Fax: (971) 314-4527

    Type: Location

  • 5 Neponset St

    Worcester, MA 016062714

    Phone: (508) 556-5400

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

Open Payments (CMS)

CMS reports 23 Open Payments records for all available years, with a total value of $858.

Total Amount is formed as General ($858) + Research ($0) + Ownership ($0) = $858.

Last reported payment date: 2024-12-25 • Largest payer in this snapshot: ABBVIE INC. ($124).

Total Amount

$858

General + Research + Ownership

Payments

23

Total payment records

General Amount

$858

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-25

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

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

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-10-02

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20180827002355IHematology/OncologyMATBD
I20241002002058IHematology/OncologyORTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
Q0138Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use)6,63012$0
J1756Injection, iron sucrose, 1 mg3,10012$0
99215Established patient office or other outpatient visit, 40-54 minutes9249$0
96375Injection of additional new drug or substance into vein7336$0
J3489Injection, zoledronic acid, 1 mg6814$0
View full utilization report →

Insurance plans in this area (ZIP 01655)

Loading plans...

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: 0648719989View full group profile
NameSpecialtyState
Nurse PractitionerOR
Nurse PractitionerOR
Hematology/Oncology, Internal MedicineMA

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

Can I use this page to confirm PATAN GULTAWATVICHAI (M.D.)'s NPI?
Yes. PATAN GULTAWATVICHAI (M.D.) is listed with NPI 1720335987 in the public NPI dataset.
Is PATAN GULTAWATVICHAI (M.D.) still practicing?
PATAN GULTAWATVICHAI (M.D.) is currently listed as active in the public NPI registry.
What is PATAN GULTAWATVICHAI (M.D.) best known for clinically?
Directory data describes PATAN GULTAWATVICHAI (M.D.) with Hematology & Oncology Physician. Clinical services aligned with this taxonomy classification.
Where should I expect PATAN GULTAWATVICHAI (M.D.) on a map?
Expect Worcester, Massachusetts as a primary anchor for PATAN GULTAWATVICHAI (M.D.) unless the record lists multiple sites.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.