UMASS MEMORIAL MEDICAL GROUP INC – Internal Medicine Physician, NPI 1760445373
Internal Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for UMASS MEMORIAL MEDICAL GROUP INC
PO Box 846028, Albany Street, Church Green, Financial District, Boston, Suffolk County, Massachusetts, 02284-6028, United States
ATTN: PROVIDER ENROLLMENT DEPARTMENT
BOSTON, MA 022415348
Phone: (508) 334-8015
Fax: (508) 334-8105
Type: Mailing
UMASS Memorial Medical Center University Campus Hospital, 55, Lake Avenue North, Worcester, Worcester County, Massachusetts, 01653, United States
WORCESTER, MA 016550002
Phone: (508) 334-1000
Type: Location
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.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-05-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2026-04-30 (41 days ago).
Enrollment records
12
Earliest due date
2026-04-30
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040113000267 | O | Clinic/Group Practice | MA | TBD |
| O20210203001055 | O | Mass Immunization (Roster Biller Only) | MA | 2026-04-30 |
| O20220930001418 | O | Clinic/Group Practice | CO | TBD |
| O20221221001243 | O | Clinic/Group Practice | NH | TBD |
| O20230105000062 | O | Clinic/Group Practice | RI | TBD |
| O20230124000420 | O | Clinic/Group Practice | ME | TBD |
| O20230222000139 | O | Clinic/Group Practice | NJ | TBD |
| O20240228001769 | O | Clinic/Group Practice | NY | TBD |
| O20240319000989 | O | Clinic/Group Practice | OR | TBD |
| O20240319003483 | O | Clinic/Group Practice | CA | TBD |
| O20240409001723 | O | Clinic/Group Practice | MI | TBD |
| O20240417001154 | O | Clinic/Group Practice | VA | TBD |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 02241)
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