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JOHN MARK MADISON M.D.
NPI 1821070244
Internal Medicine - Pulmonary Disease in Worcester, MA

Active since November 20, 2005PECOS EnrolledAccepts Medicare Assignment
97.02/100
CMS Quality Rating
55 LAKE AVE N, DEPARTMENT OF PULMONARY MEDICINE, WORCESTER, MA 01655(508) 856-6938(508) 856-3999 Get Directions Write a Review

NPPES record last updated: November 18, 2020. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About John Mark Madison M.d. NPPES

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

JOHN MARK MADISON M.D. (NPI 1821070244) is an individual pulmonary disease provider in Worcester, Massachusetts, licensed in Massachusetts (72090) and active in the NPI registry since November 2005. He is enrolled in Medicare PECOS, is affiliated with Umass Memorial Health - Harrington Hospital, and is a graduate of Harvard Medical School (1979).

NPPES Registry Identity

NPI1821070244
Entity TypeIndividualMale
Primary Taxonomy207RP1001X
Provider Legal NameJOHN MARK MADISONCredential: M.D.
Location Address55 LAKE AVE N, DEPARTMENT OF PULMONARY MEDICINEWorcester, MA 01655-0002
Mailing AddressPo Box 415348Boston, MA 02241-5348
Phone(508) 856-6938
Fax(508) 856-3999
Sole ProprietorNo
Medical School CMSHarvard Medical SchoolGraduated 1979
Enumeration DateNovember 20, 2005
Last NPPES UpdateNovember 18, 2020
NPPES CertifiedNovember 18, 2020
✔ NPI 1821070244 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Pulmonary DiseaseAllopathic & Osteopathic Physicians
Taxonomy Code207RP1001X
License✔ Licensed in MA · 72090
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.
55 LAKE AVE N, Worcester, MA 01655
Open in Google Maps ↗

Other Identifiers 1

Medicaid3057275MA

Accepted Insurance

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

John Mark Madison 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 ID5496764284
PECOS Enrollment IDI20060405000606
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 11

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.

Test to examine how well the lungs exchange gases 94729
This is a test called a pulmonary function test, which helps understand the efficiency of your lungs. It measures how much air your lungs can hold, how quickly you can move air in and out of your lungs, and how well your lungs put oxygen into and remove carbon dioxide from your blood.
614 services597 patients
Test to measure expiratory airflow and volume 94010
This test, known as spirometry, assesses how well your lungs work. It measures how much air you can inhale, how much you can exhale and how quickly you can exhale. It's non-invasive and helps diagnose conditions like asthma or COPD.
450 services427 patients
Test to determine lung volumes using gas dilution or washout 94727
This test measures lung volumes by either diluting or washing out a known amount of gas in your lungs. You'll breathe in a harmless gas, then exhale. The exhaled air is analyzed to assess your lung capacity and function.
348 services347 patients
Test to measure expiratory airflow and volume changes before and after medication administration 94060
This procedure measures how air flows in and out of your lungs. It's done before and after medication to see if the treatment improves your breathing. It's a simple, non-invasive test that involves breathing into a device called a spirometer.
330 services325 patients
Test to determine lung volumes using sensors 94726
This test, called spirometry, measures lung capacity using sensors. You breathe into a mouthpiece attached to a device that records the amount and rate of air you inhale and exhale. It helps diagnose and monitor lung conditions.
136 services135 patients
Test to measure lung airway sensitivity 94070
This procedure, called a Bronchial Challenge Test, evaluates how sensitive your lungs are to substances that may cause asthma symptoms. You'll inhale a certain substance, and then your lung function is measured. It aids in diagnosing and managing asthma.
92 services91 patients

Hospital Affiliations CMS Care Compare 4

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

Umass Memorial Health - Harrington Hospital

Acute Care Hospitals · Southbridge, MA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220019
Location100 South StreetSouthbridge, MA 01550 · Worcester County
Emergency services

Umass Memorial Healthcare-Marlborough Hospital

Acute Care Hospitals · Marlborough, MA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220049
Location157 Union StreetMarlborough, MA 01752 · Middlesex County
Emergency services

Umass Memorial Medical Center/University Campus

Acute Care Hospitals · Worcester, MA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220163
Location55 Lake Avenue NorthWorcester, MA 01655 · Worcester County
Emergency services Birthing friendly

St Vincent Hospital

Acute Care Hospitals · Worcester, MA
2/5 CMS rating
OwnershipProprietary
CMS Certification Number220176
Location123 Summer StreetWorcester, MA 01608 · Worcester County
Emergency services Birthing friendly

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
$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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

97.02/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality78.09
Promoting Interoperability100
Improvement Activities40

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. 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
YOONYIE CHO M.D.
Anesthesiology
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-1000

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 John Madison's NPI number?

The NPI number for John Madison is 1821070244. It was assigned to this individual provider in the NPPES registry on November 20, 2005.

Where is John Madison located?

John Madison practices at 55 Lake Ave N Department Of Pulmonary Medicine, Worcester, MA 01655. The listed phone number is (508) 856-6938.

What is John Madison's specialty?

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

Is John Madison enrolled in Medicare?

Yes. John Madison 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 John Madison accept?

Health plans from Anthem Blue Cross and Blue Shield list John Madison 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 John Madison affiliated with any hospitals?

According to CMS data, John Madison is affiliated with Umass Memorial Health - Harrington Hospital, Umass Memorial Healthcare-Marlborough Hospital, Umass Memorial Medical Center/University Campus and St Vincent Hospital.

When was this NPI record last updated?

The NPPES record for John Madison was last updated on November 18, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.