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GVANTSA DIDEBULIDZE M.D
NPI 1730474644
Internal Medicine in Brockton, MA

Active since June 20, 2011PECOS EnrolledAccepts Medicare Assignment
63 MAIN ST, BROCKTON, MA 02301(508) 559-6699(508) 559-5073 Get Directions Write a Review

NPPES record last updated: May 19, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Gvantsa Didebulidze M.d NPPES

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

GVANTSA DIDEBULIDZE M.D (NPI 1730474644) is an individual internal medicine provider in Brockton, Massachusetts, licensed in Massachusetts (257775) and active in the NPI registry since June 2011. She is enrolled in Medicare PECOS, is affiliated with Northeast Hospital Corporation, and is a graduate of Other (2009).

NPPES Registry Identity

NPI1730474644
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameGVANTSA DIDEBULIDZECredential: M.D
Location Address63 MAIN STBrockton, MA 02301-4042
Mailing Address63 Main StBrockton, MA 02301-4042 · (508) 559-6699 · Fax (508) 559-5073
Phone(508) 559-6699
Fax(508) 559-5073
Sole ProprietorNo
Medical School CMSOtherGraduated 2009
Enumeration DateJune 20, 2011
Last NPPES UpdateMay 19, 2025
NPPES CertifiedMay 19, 2025
✔ NPI 1730474644 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in MA · 257775
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
63 MAIN ST, Brockton, MA 02301
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Accepted Insurance

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

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Gvantsa Didebulidze M.d is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID143441758
PECOS Enrollment IDI20141024000170
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.

Areas of Expertise CMS Part B claims 8

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
124 services86 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
119 services87 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
46 services46 patients
Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
43 services42 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
38 services37 patients
Hemoglobin a1c level 83036
Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.
34 services24 patients

Hospital Affiliations CMS Care Compare 5

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Northeast Hospital Corporation

Acute Care Hospitals · Beverly, MA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220033
Location85 Herrick StreetBeverly, MA 01915 · Essex County
Emergency services Birthing friendly

North Shore Medical Center -

Acute Care Hospitals · Salem, MA
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220035
Location81 Highland AvenueSalem, MA 01970 · Essex County
Emergency services Birthing friendly

Massachusetts General Hospital

Acute Care Hospitals · Boston, MA
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220071
Location55 Fruit StreetBoston, MA 02114 · Suffolk County
Emergency services Birthing friendly

Winchester Hospital

Acute Care Hospitals · Winchester, MA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220105
Location41 Highland AvenueWinchester, MA 01890 · Middlesex County
Emergency services Birthing friendly

Lahey Hospital & Medical Center, Burlington

Acute Care Hospitals · Burlington, MA
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220171
Location41 & 45 Mall RoadBurlington, MA 01803 · Middlesex County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 02301 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
$134.47 typical visit price
range $58.86 – $177.36
Typical copayment $33.61 (range $14.71 – $44.34)
Most-billed visit code 99204
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.

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Walker, heavy duty, wheeled, rigid or folding, any type E0149
DME-Other DME · category DE000N
1 supplier11 claims11 services$7.33 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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.

GLORIA IBARRA M.D.
Internal Medicine (Endocrinology, Diabetes & Metabolism)
63 MAIN ST
BROCKTON, MA 02301
Plymouth County (508) 559-6699
SAIRA GHANY
Dental Hygienist
63 MAIN ST
BROCKTON, MA 02301
Plymouth County (508) 559-6699
JANINA MARIE COLAVITA NP
Nurse Practitioner (Adult Health)
63 MAIN ST
BROCKTON, MA 02301
Plymouth County (508) 894-3473
ELSIE VARUGHESE M.D.
Internal Medicine
63 MAIN ST
BROCKTON, MA 02301
Plymouth County (508) 559-6699
DR. TRANG THANH NGUYEN DMD
Dentist (General Practice)
63 MAIN ST
BROCKTON, MA 02301
Plymouth County (508) 559-6699
SHEINA JEAN-MARIE DMD
Dentist (General Practice)
63 MAIN ST
BROCKTON, MA 02301
Plymouth County (508) 559-6699
GRIGOR MARTIROSYAN OD
Optometrist
63 MAIN ST
BROCKTON, MA 02301
Plymouth County (508) 894-3444
JACQUELINE SPENCER
Registered Nurse
63 MAIN ST
BROCKTON, MA 02301
Plymouth County (508) 559-6699

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 Gvantsa Didebulidze's NPI number?

The NPI number for Gvantsa Didebulidze is 1730474644. It was assigned to this individual provider in the NPPES registry on June 20, 2011.

Where is Gvantsa Didebulidze located?

Gvantsa Didebulidze practices at 63 Main St, Brockton, MA 02301. The listed phone number is (508) 559-6699.

What is Gvantsa Didebulidze's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Gvantsa Didebulidze enrolled in Medicare?

Yes. Gvantsa Didebulidze is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Gvantsa Didebulidze accept?

Health plans from Anthem Blue Cross and Blue Sheld and Anthem Blue Cross and Blue Shield list Gvantsa Didebulidze 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.

Is Gvantsa Didebulidze affiliated with any hospitals?

According to CMS data, Gvantsa Didebulidze is affiliated with Northeast Hospital Corporation, North Shore Medical Center -, Massachusetts General Hospital, Winchester Hospital and Lahey Hospital & Medical Center, Burlington.

When was this NPI record last updated?

The NPPES record for Gvantsa Didebulidze was last updated on May 19, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.