Active NPI
Demin Ma, M.D.
- Psychiatry Physician
- Brockton, MA
National Provider Identifier
1013947688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 213990
- Practice address
- 680 Centre St
Brockton, MA 02302-3308 - Phone
- (508) 941-7228
- Fax
- (508) 941-6401
- NPI assigned
- Jul 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 213990 | MA | Primary |
Addresses
Primary practice location
680 Centre St
Brockton, MA 02302-3308
Mailing address
680 Centre St
Brockton, MA 02302-3308
Phone (508) 941-7009
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1200283 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 213990 | MA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brockton Hospital, Inc. | Past | Accepting new patients | |
| Brockton Hospital, Inc. | Psychiatry | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Brockton, MA
- NPI 1063431286
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305072000000",
"number": "1013947688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "680 CENTRE ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023023308",
"telephone_number": "508-941-7009",
"fax_number": "508-941-6337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "680 CENTRE ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023023308",
"telephone_number": "508-941-7228",
"fax_number": "508-941-6401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MA",
"first_name": "DEMIN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-03",
"last_updated": "2011-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MA",
"license": "213990",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1200283",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.