Congenial Physician Organization – Internal Medicine Physician, NPI 1790241735
Internal Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Congenial Physician Organization
147 S Main St
Middleton, MA 019492446
Phone: (978) 740-2555
Fax: (978) 774-8715
Type: Location
1 Walton St
Wakefield, MA 018801209
Phone: (781) 246-9131
Fax: (781) 246-9159
Type: Location
330 Lynnway Ste 109A
Lynn, MA 019011713
Phone: (781) 593-6005
Fax: (781) 593-1370
Type: Location
2 1st Ave Ste 215
Peabody, MA 019604962
Phone: (978) 740-2300
Fax: (978) 744-3993
Type: Location
Roosevelt Avenue, Peabody, Essex County, Massachusetts, 01923-1014, United States
PEABODY, MA 019602227
Phone: (978) 536-0215
Fax: (978) 536-0230
Type: Mailing
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.
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-05-31 (744 days ago).
Enrollment records
1
Earliest due date
2024-05-31
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 |
|---|---|---|---|---|
| O20171016002508 | O | Clinic/Group Practice | MA | 2024-05-31 |
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 01949)
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