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1340 Boylston St Boston MA 02215-4302 | |
| (617) 927-4880 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1340 Boylston St, Boston, Massachusetts |
| Authorized Official Name and Position | Jeff Lieberman (VP FINANCE & ADMINISTRATION) |
| Authorized Official Contact | 6179276173 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1340 Boylston St Boston MA 02215-4302 Ph: (617) 927-4880 | 1340 Boylston St Boston MA 02215-4302 Ph: (617) 927-4880 |
| NPI Number | 1003804725 |
|---|---|
| Provider Enumeration Date | 10/06/2005 |
| Last Update Date | 07/07/2011 |
| Medicare PECOS PAC ID | 0941299655 |
|---|---|
| Medicare Enrollment ID | O20040508000030 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003804725 | NPI | - | NPPES |
| 1303546 | Medicaid | MA |
| Provider Name | Kimberly T Thurmond |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1376557942 PECOS PAC ID: 2961463583 Enrollment ID: I20041026000651 |
| Provider Name | Anne Davenas |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1306817044 PECOS PAC ID: 3577519917 Enrollment ID: I20050329000445 |
| Provider Name | Pamela K Adelstein |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306822416 PECOS PAC ID: 8729013255 Enrollment ID: I20051003000822 |
| Provider Name | Paula M Marella |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1144327214 PECOS PAC ID: 5193716033 Enrollment ID: I20060404000729 |
| Provider Name | Amy Goorin Fogelman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215909882 PECOS PAC ID: 6507875150 Enrollment ID: I20060411000177 |
| Provider Name | Richard Cook |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760496863 PECOS PAC ID: 4183716517 Enrollment ID: I20070815000416 |
| Provider Name | David Buckle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013905108 PECOS PAC ID: 6507847100 Enrollment ID: I20071212000159 |
| Provider Name | Brian Bakofen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801011465 PECOS PAC ID: 7113093832 Enrollment ID: I20080904000046 |
| Provider Name | Juan Jaime De Zengotita |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851357750 PECOS PAC ID: 0648328666 Enrollment ID: I20090501000120 |
| Provider Name | Kevin D Kapila |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346224334 PECOS PAC ID: 7012106990 Enrollment ID: I20110107000188 |
| Provider Name | Payal P Srinivasa |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1417122854 PECOS PAC ID: 3274722186 Enrollment ID: I20110107000504 |
| Provider Name | Scott Harris |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871581694 PECOS PAC ID: 9335338284 Enrollment ID: I20110107000963 |
| Provider Name | Joseph Baker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144338138 PECOS PAC ID: 5698875862 Enrollment ID: I20110120000833 |
| Provider Name | Ethan Brackett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912970633 PECOS PAC ID: 5193986685 Enrollment ID: I20120410000260 |
| Provider Name | Glenda J Savitz |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1356622047 PECOS PAC ID: 3476706490 Enrollment ID: I20121226000190 |
| Provider Name | Alex S Keuroghlian |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144541400 PECOS PAC ID: 7315105921 Enrollment ID: I20131119000547 |
| Provider Name | Richard H Gumpert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154616514 PECOS PAC ID: 3072741917 Enrollment ID: I20141029000873 |
| Provider Name | Monica D Nguyen |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1134475502 PECOS PAC ID: 9436308475 Enrollment ID: I20141222000890 |
| Provider Name | Gabriel C Belosevic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972861607 PECOS PAC ID: 9436479045 Enrollment ID: I20150522000065 |
| Provider Name | Melissa Cranston-bates |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104109099 PECOS PAC ID: 2860799665 Enrollment ID: I20160322001715 |
| Provider Name | Katherine L Da Silva |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699029744 PECOS PAC ID: 8729375399 Enrollment ID: I20160926000564 |
| Provider Name | Rebecca Match |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003282286 PECOS PAC ID: 3072899582 Enrollment ID: I20170418002211 |
| Provider Name | Supraja Janaki Rajagopalan |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1770960726 PECOS PAC ID: 7911296652 Enrollment ID: I20191016000880 |
| Provider Name | Mary Elizabeth Dy |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1336708734 PECOS PAC ID: 4981032927 Enrollment ID: I20200325001377 |
| Provider Name | Tyler Zachary Gillingham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952936353 PECOS PAC ID: 1759791882 Enrollment ID: I20201102000062 |
| Provider Name | Bradley Milam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942706668 PECOS PAC ID: 0244577716 Enrollment ID: I20231220001733 |
| Provider Name | Adam Albano |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558689828 PECOS PAC ID: 8527296540 Enrollment ID: I20240208002252 |
| Provider Name | Steven Elsesser |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104386861 PECOS PAC ID: 6103250444 Enrollment ID: I20240209002652 |
| Provider Name | Taimur Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205178449 PECOS PAC ID: 2264660554 Enrollment ID: I20240216000797 |
| Provider Name | Jimmy Kamel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770007858 PECOS PAC ID: 2365703618 Enrollment ID: I20240223002269 |
| Provider Name | Daniel Kahn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972957637 PECOS PAC ID: 1759666308 Enrollment ID: I20240226003214 |
| Provider Name | Adam D Laird |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619540614 PECOS PAC ID: 6901204031 Enrollment ID: I20240229000094 |
| Provider Name | Stephen J Dunn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932604550 PECOS PAC ID: 4688923154 Enrollment ID: I20240306001815 |
| Provider Name | Alix Vandeventer Quinn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063943249 PECOS PAC ID: 3577959428 Enrollment ID: I20240318002004 |
| Provider Name | Sarah Katharine Larsen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134756505 PECOS PAC ID: 1456708809 Enrollment ID: I20240403000283 |
| Provider Name | Jason Latsky |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568087542 PECOS PAC ID: 8022467679 Enrollment ID: I20240403002009 |
| Provider Name | Ami G Multani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376751412 PECOS PAC ID: 7911171988 Enrollment ID: I20240424000816 |
| Provider Name | Ralph G Vetters |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1427068873 PECOS PAC ID: 6103065818 Enrollment ID: I20240506003252 |
| Provider Name | Yale Pearlson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962553149 PECOS PAC ID: 8729226204 Enrollment ID: I20240511000014 |
| Provider Name | Myles Spar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013028307 PECOS PAC ID: 3072597327 Enrollment ID: I20240511000048 |
| Provider Name | Aditya Chandrasekhar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235425760 PECOS PAC ID: 2466770417 Enrollment ID: I20240515003746 |
| Provider Name | Adam Corl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154033934 PECOS PAC ID: 1355713843 Enrollment ID: I20240621002647 |
| Provider Name | Chelsea Diallo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811565179 PECOS PAC ID: 3274999602 Enrollment ID: I20240625000714 |
| Provider Name | Julia Fleming |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609216191 PECOS PAC ID: 1557658127 Enrollment ID: I20240627000626 |
| Provider Name | Julian Allroth Dormitzer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912563180 PECOS PAC ID: 3779812292 Enrollment ID: I20240710002467 |
| Provider Name | Francisco Eduardo Fantes |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1184923922 PECOS PAC ID: 3971049743 Enrollment ID: I20240729003173 |
| Provider Name | Gus Emmick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043291727 PECOS PAC ID: 9335111772 Enrollment ID: I20240729003395 |
| Provider Name | Pooja Jayaprakash |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255891248 PECOS PAC ID: 1254660541 Enrollment ID: I20240729003745 |
| Provider Name | Jennifer L Ruiz |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1104863372 PECOS PAC ID: 5799880159 Enrollment ID: I20240730001795 |
| Provider Name | Raedjio Naro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518657469 PECOS PAC ID: 0941655534 Enrollment ID: I20240731003547 |
| Provider Name | Ischel Gonzalez Kelso |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407433857 PECOS PAC ID: 8325449267 Enrollment ID: I20240731003791 |
| Provider Name | Kimberly A Lawrence |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326322108 PECOS PAC ID: 1850838970 Enrollment ID: I20240806003571 |
| Provider Name | James Edward Lunderville |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366693723 PECOS PAC ID: 5496293326 Enrollment ID: I20240809003334 |
| Provider Name | Shiliu Wang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669256160 PECOS PAC ID: 9133576325 Enrollment ID: I20240814001773 |
| Provider Name | Rebecca Henderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316195985 PECOS PAC ID: 4981143203 Enrollment ID: I20240829002919 |
| Provider Name | Christa Marie Redner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053808469 PECOS PAC ID: 2567901887 Enrollment ID: I20240829003131 |
| Provider Name | Eli Latto |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720457971 PECOS PAC ID: 2860931102 Enrollment ID: I20240829003859 |
| Provider Name | Garret Wallace |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366179764 PECOS PAC ID: 9537608880 Enrollment ID: I20240829004236 |
| Provider Name | Christopher James Poulin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619565694 PECOS PAC ID: 3274072319 Enrollment ID: I20240903002706 |
| Provider Name | Michelle Y Buescher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811368426 PECOS PAC ID: 8426359423 Enrollment ID: I20240904000106 |
| Provider Name | Theresa Blackman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669921482 PECOS PAC ID: 4082154158 Enrollment ID: I20240904004181 |
| Provider Name | Tucker Meijer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205518313 PECOS PAC ID: 9931649688 Enrollment ID: I20240909001525 |
| Provider Name | Meredith Walker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356657910 PECOS PAC ID: 5991245680 Enrollment ID: I20240909003087 |
| Provider Name | Wayne Pearson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811531965 PECOS PAC ID: 4587104179 Enrollment ID: I20240910002465 |
| Provider Name | Alisha Musau |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1629702634 PECOS PAC ID: 9032593983 Enrollment ID: I20240910004681 |
| Provider Name | Cristina Chandler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861774929 PECOS PAC ID: 0648419069 Enrollment ID: I20240916000463 |
| Provider Name | Rachel Marie Rome |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033883806 PECOS PAC ID: 1951842160 Enrollment ID: I20240916000788 |
| Provider Name | Jean Mcclurken |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265623839 PECOS PAC ID: 3274768981 Enrollment ID: I20240919001818 |
| Provider Name | Robyn Margaret Perry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568057552 PECOS PAC ID: 5395286157 Enrollment ID: I20240919002544 |
| Provider Name | David Nasser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518530740 PECOS PAC ID: 5092198002 Enrollment ID: I20240930000112 |
| Provider Name | Leah Crawford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932821089 PECOS PAC ID: 4587195458 Enrollment ID: I20241002002383 |
| Provider Name | Michell Lubeth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497224919 PECOS PAC ID: 6406226695 Enrollment ID: I20241021000431 |
| Provider Name | Isaac Rogers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790460970 PECOS PAC ID: 0547793135 Enrollment ID: I20241105000725 |
| Provider Name | Alexandra Evans Nagle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073331245 PECOS PAC ID: 3870027055 Enrollment ID: I20241111001928 |
| Provider Name | Sarah Marie Shelby Etherton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851566178 PECOS PAC ID: 0143491738 Enrollment ID: I20241121002962 |
| Provider Name | Molly Fadden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184306144 PECOS PAC ID: 1254867534 Enrollment ID: I20241210002706 |
Rong J Guan, Md Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 30 Kneeland St Fl 5, Boston, MA 02111 Phone: 617-290-9881 Fax: 617-350-6555 | |
Robert H. Wu. Md, Pc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 65 Harrison Ave Ste 308, Boston, MA 02111 Phone: 617-338-9889 | |
Pjtrains Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 14 Newbury St Ste 4, Boston, MA 02116 Phone: 857-205-2759 | |
Mhg Physician Services - Michigan Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 500 Harrison Ave, Boston, MA 02118 Phone: 855-340-4663 |