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MYSTIC MEDICAL GROUP, INC.
NPI 1245218676
Internal Medicine - Pulmonary Disease in Medford, MA

Active since January 05, 2006CLIA 22D0999932 · Waiver
170 GOVERNORS AVE, MEDFORD, MA 02155(781) 391-4106(781) 391-3043 Get Directions Write a Review

NPPES record last updated: October 21, 2010. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mystic Medical Group, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MYSTIC MEDICAL GROUP, INC. (NPI 1245218676) is a healthcare organization registered as a pulmonary disease in Medford, Massachusetts and active in the NPI registry since January 2006. The organization holds a CLIA Waiver certificate valid through May 28, 2028 and lists Robert S Weinstein, President, as its authorized official.

NPPES Registry Identity

NPI1245218676
Entity TypeOrganization
Primary Taxonomy207RP1001X
Legal Business NameMYSTIC MEDICAL GROUP, INC.
Location Address170 GOVERNORS AVEMedford, MA 02155-1643
Mailing Address170 Governors AveMedford, MA 02155-1643 · (781) 391-0801 · Fax (781) 391-3793
Phone(781) 391-4106
Fax(781) 391-3043
Organization SubpartNo
Authorized OfficialRobert S WeinsteinPresident · (781) 391-0801
Enumeration DateJanuary 5, 2006
Last NPPES UpdateOctober 21, 2010
✔ NPI 1245218676 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal Medicine · Pulmonary DiseaseAllopathic & Osteopathic Physicians
Taxonomy Code207RP1001X
Definition

An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.

Also ListedInternal MedicineTaxonomy 207R00000X
Also ListedInternal Medicine · Endocrinology, Diabetes & MetabolismTaxonomy 207RE0101X
170 GOVERNORS AVE, Medford, MA 02155
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Other Identifiers 3

OtherM17957Blue Cross Group
Other688708Tufts Group
Medicare ID-Type UnspecifiedM21076Group

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 22D0999932

Mystic Medical Group Inc · Medford, MA
Active · expires May 28, 2028
CLIA Number22D0999932
Laboratory TypePhysician Office
Certificate Effective DateMay 29, 2026
Certificate Expiration DateMay 28, 2028
Laboratory DirectorMargot Hartunian MD
Laboratory Phone(781) 391-4106
Laboratory LocationMystic Medical Group Inc170 Governors Avenue, Medford, MA 02155
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ELLEN DIANA KLEE NP
Nurse Practitioner (Adult Health)
170 GOVERNORS AVE, LAWRENCE MEMORIAL HOSPITAL-DIABETES CENTER
MEDFORD, MA 02155
Middlesex County (781) 306-6370
MRS. KERRI ANNE DEWOLF
Social Worker (Clinical)
170 GOVERNORS AVE
MEDFORD, MA 02155
Middlesex County (781) 306-6157
SHARON HALL RNCS
Clinical Nurse Specialist (Psychiatric/Mental Health)
170 GOVERNORS AVE, LAWRENCE MEMORIAL HOSPITAL
MEDFORD, MA 02155
Middlesex County (781) 306-6150
MICHELLE VIDAL LICSW
Social Worker (Clinical)
170 GOVERNORS AVE, LAWRENCE MEMORIAL HOSPITAL
MEDFORD, MA 02155
Middlesex County (781) 306-6008
ANDREA MESSINA N.P.
Nurse Practitioner (Adult Health)
170 GOVERNORS AVE
MEDFORD, MA 02155
Middlesex County (781) 306-6000
DR. JOSEPH M MURPHY JR. M.D.
Internal Medicine
170 GOVERNORS AVE
MEDFORD, MA 02155
Middlesex County (781) 391-4106
MRS. CAMILLE ROSE ROSSETTI P.T.A.
Physical Therapy Assistant
170 GOVERNORS AVE
MEDFORD, MA 02155
Middlesex County (781) 395-7750
EILEEN WEGENER MD
Internal Medicine
170 GOVERNORS AVE
MEDFORD, MA 02155
Middlesex County (781) 306-6102

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mystic Medical Group, Inc.'s NPI number?

The NPI number for Mystic Medical Group, Inc. is 1245218676. It was assigned to this organization in the NPPES registry on January 5, 2006.

Where is Mystic Medical Group, Inc. located?

Mystic Medical Group, Inc. is located at 170 Governors Ave, Medford, MA 02155. The listed phone number is (781) 391-4106.

What is Mystic Medical Group, Inc.'s specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Pulmonary Disease, with taxonomy code 207RP1001X.

Does Mystic Medical Group, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 22D0999932) is associated with this NPI, valid through May 28, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Mystic Medical Group, Inc. accept?

Health plans from Anthem Blue Cross and Blue Shield list Mystic Medical Group, Inc. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mystic Medical Group, Inc. was last updated on October 21, 2010. NPI Profile syncs with the weekly NPPES data releases published by CMS.