Active NPI 1992854681 Individual Practitioner Male Practitioner

Dr. James Carroll , MD

Surgery • Worcester, MA

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. James Carroll, MD is a certified Surgery practicing in Worcester, MA. With approximately 20 years of clinical experience since graduating from Warren Alpert Medical School Of Brown University in 2006, Dr. Carroll delivers high-quality medical care to the local community at 55 LAKE AVE N.

Dr. Carroll is affiliated with Umass Memorial Medical Group Inc and accepts Medicare assignment.

Frequently performed procedures and clinical services include established patient outpatient office visit, new patient outpatient office visit, initial hospital care with straightforward or low-level medical decision making, if using time, at least. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

55 Lake Ave N
Department Of Surgery

Worcester, MA 016550002

Telephone 5083340545

Fax 7744430544

Associated Practice Facility / Clinic

🏢 Umass Memorial Medical Center Facility NPI 1679574933

Medicare Profile & Education

Medical School

Warren Alpert Medical School Of Brown University

Graduation Year

2006

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Surgery in Worcester, MA

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

20 Yrs -3.4 yrs vs City Avg

City Avg: 23.4 Yrs

State Avg: 28.2 Yrs

Regional Practice Density

48 Specialists

Practicing in Worcester, MA (1077 Statewide)

Telehealth Adoption Rate

20.8% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

77.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Carroll (20 Years) 20 Yrs

Worcester Specialty Average (23.4 Years) 23.4 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	60	50	$300.00	$64.35
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	57	57	$358.84	$79.56
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	40	37	$450.00	$129.18
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	26	16	$238.00	$77.69
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	13	13	$445.00	$96.33
47562 Removal of gallbladder using an endoscope	13	13	$3138.00	$658.92
49650 Repair of groin hernia using an endoscope	13	13	$1956.77	$448.38

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	74	74	$359.00	$84.24
99213 Established patient office or other outpatient visit, typically 15 minutes	63	53	$282.22	$67.28
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	46	46	$450.00	$129.68
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	43	26	$238.00	$79.52
49650 Repair of groin hernia using an endoscope	14	14	$2076.57	$475.92

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	60	48	$244.00	$67.57
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	55	55	$359.00	$85.75
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	38	35	$450.00	$139.37
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	25	18	$238.00	$73.64

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	54	27	$232.04	$74.67
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	52	52	$441.87	$141.14
99213 Established patient office or other outpatient visit, typically 15 minutes	51	38	$241.06	$70.56
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	46	46	$358.57	$86.16

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	61	60	$403.00	$146.02
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	61	45	$215.00	$76.40
99213 Established patient office or other outpatient visit, typically 15 minutes	41	32	$214.00	$54.35
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	40	40	$349.00	$80.28
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	16	15	$316.00	$83.30
99238 Hospital discharge day management, 30 minutes or less	13	13	$245.00	$77.58

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	79	61	$213.24	$53.47
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	71	71	$348.31	$78.37
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	49	28	$214.29	$76.06
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	27	27	$401.00	$143.23
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	24	22	$314.33	$77.82
99238 Hospital discharge day management, 30 minutes or less	17	17	$244.71	$76.64

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	69	39	$210.00	$75.63
99213 Established patient office or other outpatient visit, typically 15 minutes	51	39	$199.00	$53.25
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	49	49	$342.00	$77.06
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	29	24	$296.00	$79.14
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	24	24	$385.00	$141.96
99238 Hospital discharge day management, 30 minutes or less	22	22	$240.00	$76.09
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	21	21	$566.00	$210.68
99221 Initial hospital inpatient care per day, typically 30 minutes	20	20	$282.00	$105.44
47562 Removal of gallbladder using an endoscope	11	11	$3280.64	$685.01

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	42	31	$296.00	$79.64
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	40	40	$338.50	$78.40
99213 Established patient office or other outpatient visit, typically 15 minutes	39	34	$199.00	$52.12
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	16	16	$476.75	$132.65

Medical Specialties & State Licenses

CMS Verified: 2020-11-02

Surgery Primary Specialty

NUCC Taxonomy Code: 208600000X

State License MA 238407

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

110095660A (MA)

Hospital & Practice Group Affiliations

Umass Memorial Medical Group Inc

155 Union St, Marlborough, MA 017521228

Phone: 5084817390

Umass Memorial Medical Group Inc

119 Belmont St, Worcester, MA 016052903

Phone: 5083341000

Umass Memorial Medical Group Inc

55 Lake Ave N, Worcester, MA 016550002

Phone: 5083341000

Umass Memorial Medical Group Inc

157 Union St, Marlborough, MA 017521228

Phone: 5084865521

Umass Memorial Medical Group Inc

281 Lincoln St, Worcester, MA 016052138

Phone: 5083341000

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

9 Associated Practitioners

Robin Mason , NP

Nurse Practitioner

NPI 1033185590

Nurse Practitioner

Dr. John Kelly , MD

Surgery

NPI 1235592882

Doctor of Medicine (M.D.)

Dr. John Kelly , MD

Surgery

NPI 1356325062

Doctor of Medicine (M.D.)

Dr. Nicole Cherng , MD

Surgery

NPI 1366860892

Doctor of Medicine (M.D.)

Robert Benjamin

Surgery

NPI 1528645561

Melissa Potter , PA-C

Physician Assistant

NPI 1609841097

Physician Assistant (Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events

✅

NPI Profile Active April 24, 2017

NPI status registered as active in NPPES database

📍

Updated Practice Location April 24, 2017

Registered at 55 LAKE AVE N, DEPARTMENT OF SURGERY, WORCESTER, MA 016550002 (Tel: 5083340545)

📍

Updated Business Mailing Address April 24, 2017

Registered at PO BOX 415348, BOSTON, MA 022415348 (Tel: 8002258885)

👤

Provider Name / Credentials Updated April 24, 2017

Recorded as JAMES CARROLL, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) April 24, 2017

Surgery (License #238407 in MA)

✅

NPI Profile Active April 19, 2013

NPI status registered as active in NPPES database

📍

Updated Practice Location April 19, 2013

Registered at 55 LAKE AVE N, DEPARTMENT OF SURGERY, WORCESTER, MA 016550002 (Tel: 5083340545)

📍

Updated Business Mailing Address April 19, 2013

Registered at PO BOX 415348, BOSTON, MA 022415348 (Tel: 8002258885)

👤

Provider Name / Credentials Updated April 19, 2013

Recorded as JAMES CARROLL, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) April 19, 2013

Surgery (License #238407 in MA)

🟢

Initial NPI Registration & Enumeration January 10, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1992854681

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: January 10, 2007

Last Update: November 02, 2020

Sole Proprietor: No

Update or Correct Profile

Mailing Address

Po Box 415348

Boston, MA 022415348

Phone: 8002258885

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.