DR. THOMAS J GUGGINA M.D.
NPI 1669454708
Pediatrics in Worcester, MA
NPI Status: Active since November 15, 2005
Contact Information
55 LAKE AVE N
DEPARTMENT OF PEDIATRIC HOSPITAL MEDICINE
WORCESTER, MA
ZIP 01655
Phone: (508) 334-7986
Fax: (508) 334-7989
- Individual
- Male
- Pediatrics
- PECOS Enrolled
About THOMAS GUGGINA
This page provides the complete NPI Profile along with additional information for Thomas Guggina, a pediatrician established in Worcester, Massachusetts with a medical specialization in Pediatrics. The healthcare provider is registered in the NPI registry with number 1669454708 assigned on November 2005. The practitioner's primary taxonomy code is 208000000X with license number 214570 (MA). The provider is registered as an individual and his NPI record was last updated 5 years ago.
- NPI
- 1669454708
- Provider Name
- DR. THOMAS J GUGGINA M.D.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 55 LAKE AVE N DEPARTMENT OF PEDIATRIC HOSPITAL MEDICINE WORCESTER, MA 01655
- Location Phone
- (508) 334-7986
- Location Fax
- (508) 334-7989
- Mailing Address
- PO BOX 415348 BOSTON, MA 02241
- Mailing Phone
- (800) 225-8885
- Mailing Fax
- (508) 334-7989
- Is Sole Proprietor?
- No
- Enumeration Date
- 11-15-2005
- Last Update Date
- 11-16-2020
- Code Navigator
A pediatrician like Thomas Guggina is a physician who has completed a pediatric residency and is board-certified or board-eligible in a pediatric specialty. Pediatric care providers are trained to care for newborns, infants, children and adolescents. A pediatrician could perform physical exams, manage vaccinations, monitor development milestones, diagnose illnesses, infections, injuries or other health problems, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Pediatrics
- Taxonomy Code
- 208000000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 214570
- License State
- MA
- Taxonomy Description
- A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 110006792A | MEDICAID (05) | MA | |
| A3422901 | OTHER (01) | MA | MEDICARE |
Medicare Participation & PECOS Enrollment Status
Thomas Guggina is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Physician Visit Costs
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 01655 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $90.7
- Minimum New Patient Price $58.86
- Maximum New Patient Price $177.36
- Average New Patient Copayment $22.67
- Minimum New Patient Copayment $14.71
- Maximum New Patient Copayment $44.34
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $103.48
- Minimum Established Patient Price $19.11
- Maximum Established Patient Price $144.84
- Average Established Patient Copayment $25.87
- Minimum Established Patient Copayment $4.77
- Maximum Established Patient Copayment $36.21
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 6 | 6 | 9 | 4 | 5 | 4 | 7 | 0 | 8 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 6 | 12 | 9 | 8 | 5 | 8 | 7 | 0 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 6 + 1 + 2 + 9 + 8 + 5 + 8 + 7 + 0 + 24 = 72 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 80 - 72 = 8 | 8 | ||||||||
The NPI number 1669454708 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1457352775 | DR. SARAH BETH SAXER PHARMD Individual | Pharmacist (Pharmacotherapy) | 55 LAKE AVE N UMASS MED CENTER DEPT OF PHARMACY WORCESTER, MA 01655 (508) 856-2763 |
| 1891797361 | MARTHA LAROSE SAMPSON CRNA Individual | Nurse Anesthetist, Certified Registered | 55 LAKE AVE N DEPARTMENT OF ANESTHESIOLOGY WORCESTER, MA 01655 (508) 334-3271 |
| 1902899370 | LINDA A PAPE M.D. Individual | Internal Medicine (Cardiovascular Disease) | 55 LAKE AVE N CARDIOLOGY WORCESTER, MA 01655 (508) 856-3050 |
| 1124013271 | DR. DALE E RAUCH M.D. Individual | Psychiatry & Neurology (Psychiatry) | 55 LAKE AVE N WORCESTER, MA 01655 (508) 856-6580 |
| 1225025562 | DR. MAICHI T TRAN PHARM.D. Individual | Pharmacist (Pharmacotherapy) | 55 LAKE AVE N WORCESTER, MA 01655 (508) 856-1618 |
| 1427045509 | DR. JENNIFER L DONOVAN PHARM.D. Individual | Pharmacist | 55 LAKE AVE N WORCESTER, MA 01655 (508) 856-4101 |
| 1215925516 | JESSICA L DOUGLAS MS Individual | Genetic Counselor, MS | 55 LAKE AVE N S1-710 WORCESTER, MA 01655 (508) 334-3517 |
| 1295723310 | DR. JULIANNE PATRICIA HUBER MD Individual | Emergency Medicine | 55 LAKE AVE N WORCESTER, MA 01655 (508) 421-1400 |
| 1013906999 | DR. CHRISTIAN HARTMAN PHARMD Individual | 55 LAKE AVE N PHARMACY DEPARTMENT WORCESTER, MA 01655 (508) 334-7832 | |
| 1609866607 | ELLEN M GRAVALLESE M.D. Individual | Internal Medicine (Rheumatology) | 55 LAKE AVE N WORCESTER, MA 01655 (508) 334-5224 |
| 1437149804 | RAIMIS MATULIONIS MD Individual | Anesthesiology | 55 LAKE AVE N DEPARTMENT OF ANESTHESIOLOGY WORCESTER, MA 01655 (508) 334-3271 |
| 1497745806 | DR. ABIGAIL ADAMS M.D. Individual | Internal Medicine | 55 LAKE AVE N DEPARTMENT OF GENERAL MEDICINE WORCESTER, MA 01655 (508) 856-2731 |
| 1710977046 | GAMZE AYATA MD Individual | Pathology (Anatomic Pathology) | 55 LAKE AVE N DEPARTMENT OF PATHOLOGY WORCESTER, MA 01655 (508) 793-6100 |
| 1821088139 | DR. MARIANNE E FELICE M.D. Individual | Pediatrics (Adolescent Medicine) | 55 LAKE AVE N DEPARTMENT OF PEDIATRIC ADOLESCENT MEDICINE WORCESTER, MA 01655 (508) 856-3199 |
| 1750371910 | SUYANG HAO MD Individual | Pathology (Anatomic Pathology) | 55 LAKE AVE N DEPARTMENT OF PATHOLOGY WORCESTER, MA 01655 (508) 793-6100 |
| 1437140308 | JOHN PULLERITS M.D. Individual | Anesthesiology | 55 LAKE AVE N DEPARTMENT OF ANESTHESIOLOGY WORCESTER, MA 01655 (508) 334-3271 |
| 1558352492 | DIANA I. KOUZNETSOV MD Individual | Anesthesiology | 55 LAKE AVE N DEPARTMENT OF ANESTHESIOLOGY WORCESTER, MA 01655 (508) 334-3271 |
| 1174514764 | OSCAR EPHRAM STAROBIN MD Individual | Internal Medicine (Cardiovascular Disease) | 55 LAKE AVE N WORCESTER, MA 01655 (508) 856-3603 |
| 1942291570 | DR. STANLEY K TAM MD Individual | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 55 LAKE AVE N DEPARTMENT OF SURGERY WORCESTER, MA 01655 (508) 334-3962 |
| 1558352922 | MICHAEL C. BUTLER MD Individual | Emergency Medicine | 55 LAKE AVE N DEPARTMENT OF EMERGENCY MEDICINE WORCESTER, MA 01655 (508) 421-1400 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1669454708, enumerated in the NPI registry as an "individual" on November 15, 2005
The provider is located at 55 Lake Ave N Department Of Pediatric Hospital Medicine Worcester, Ma 01655 and the phone number is (508) 334-7986
The provider's speciality is Pediatrics with taxonomy code 208000000X
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
Medicare beneficiaries should expect a typical cost of $90.7 with an average copayment of $22.67 for new patient appointments. Established patients should expect a typical charge of $103.48 and an average copayment of 25.87. Please review your insurance plan or contact the provider directly to determine your specific costs.
This NPI record was last updated on November 15, 2005. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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