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DR. THOMAS J GUGGINA M.D.
NPI 1669454708
Pediatrics in Worcester, MA

Active since November 15, 2005PECOS Enrolled
55 LAKE AVE N, DEPARTMENT OF PEDIATRIC HOSPITAL MEDICINE, WORCESTER, MA 01655(508) 334-7986(508) 334-7989 Get Directions Write a Review

NPPES record last updated: December 23, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 23, 2025, Nov 16, 2020, May 25, 2017 (3 updates tracked since 2017).

About Dr. Thomas J Guggina M.d. NPPES

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

DR. THOMAS J GUGGINA M.D. (NPI 1669454708) is an individual pediatrics provider in Worcester, Massachusetts, licensed in Massachusetts (214570) and active in the NPI registry since November 2005. He is enrolled in Medicare PECOS and maintains a secondary practice location in Brockton.

NPPES Registry Identity

NPI1669454708
Entity TypeIndividualMale
Primary Taxonomy208000000X
Provider Legal NameDR. THOMAS J GUGGINACredential: M.D.
Location Address55 LAKE AVE N, DEPARTMENT OF PEDIATRIC HOSPITAL MEDICINEWorcester, MA 01655-0002
Mailing AddressPo Box 415348Boston, MA 02241-5348 · (800) 225-8885 · Fax (508) 334-1977
Phone(508) 334-7986
Fax(508) 334-7989
Sole ProprietorNo
Enumeration DateNovember 15, 2005
Last NPPES UpdateDecember 23, 20253 updates tracked since enumeration
NPPES CertifiedDecember 23, 2025
✔ NPI 1669454708 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in MA · 214570
Definition
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.
55 LAKE AVE N, Worcester, MA 01655
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Secondary Practice Location 1

Location 1680 Centre StBrockton, MA 02302-3308 · Phone (508) 941-7000

Other Identifiers 2

Medicaid110006792AMA
OtherA3422901MA · Medicare

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Taro Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Thomas J Guggina M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Thomas Guggina reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Pratt Pediatric Associates Inc
36 mi
Pediatrics
800 WASHINGTON ST, BOX 1013
Boston, MA 02111
  • Reassigned Medicare billing, Massachusetts enrollment
  • 202 clinicians in this Medicare group
NPI 1477590511 (617) 636-5000
Signature Healthcare Medical Group Inc
39 mi
Internal Medicine
110 LIBERTY ST
Brockton, MA 02301
  • Reassigned Medicare billing, Massachusetts enrollment
  • 409 clinicians in this Medicare group
NPI 1508804949 (508) 894-0400

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 01655 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$90.70 typical visit price
range $58.86 – $177.36
Typical copayment $22.67 (range $14.71 – $44.34)
Most-billed visit code 99203
Established Patient
$103.48 typical visit price
range $19.11 – $144.84
Typical copayment $25.87 (range $4.77 – $36.21)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

HILLARY R. IRONS MD
Emergency Medicine
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 421-1400
MS. SHERINE MARY HASSEY-HALLIGAN NP
Nurse Practitioner
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-8585
MS. EILEEN A. DUHAMEL NP
Nurse Practitioner
55 LAKE AVE N, DEPARTMENT OF RADIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-2710
EWA HRYNISZYN CRNA
Nurse Anesthetist, Certified Registered
55 LAKE AVE N, DEPARTMENT OF ANESTHESIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-3271
HELEN COPSEY PA-C
Physician Assistant
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-8585
DR. ADEPEJU GBADEBO CHAMPION M.D.
Internal Medicine
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-2731
SOWMYA KORAPATI
Internal Medicine (Hematology & Oncology)
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-3550
LAYLA FAKHRZADEH M.D.
Anesthesiology
55 LAKE AVE N, ANESTHESIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-3271

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 Thomas Guggina's NPI number?

The NPI number for Thomas Guggina is 1669454708. It was assigned to this individual provider in the NPPES registry on November 15, 2005.

Where is Thomas Guggina located?

Thomas Guggina practices at 55 Lake Ave N Department Of Pediatric Hospital Medicine, Worcester, MA 01655. The listed phone number is (508) 334-7986.

What is Thomas Guggina's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Thomas Guggina enrolled in Medicare?

Yes. Thomas Guggina is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Thomas Guggina's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Thomas Guggina reassigns Medicare benefits to 2 organizations: Pratt Pediatric Associates Inc (Boston, MA) and Signature Healthcare Medical Group Inc (Brockton, MA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Thomas Guggina's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Thomas Guggina accept?

Health plans from Taro Health list Thomas Guggina 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 Thomas Guggina was last updated on December 23, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.