Individual provider Active NPI

Alona Rotkovitch, NP

  • Adult Health Nurse Practitioner
  • Braintree, MA
National Provider Identifier
1023079258
Registry record updated Jun 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
130542 Issued in MA
Practice address
111 Grossman Dr
Braintree, MA 02184-4997
Phone
(781) 849-1000
NPI assigned
Mar 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 130542 MA
Adult Health Nurse Practitioner 363LA2200X 130542 MA Primary

Addresses

Primary practice location

111 Grossman Dr
Braintree, MA 02184-4997

Mailing address

147 Milk St
Provider Enrollment - 9TH Floor
Boston, MA 02109-4806

Other identifiers 3

IdentifierTypeStateIssuer
N365OtherMAHARVARD PILGRIM
NP1801OtherMABLUE CROSS
0359840MedicaidMA

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
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
130542MAMDAdult Health Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1023079258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 MILK ST",
            "address_2": "PROVIDER ENROLLMENT - 9TH FLOOR",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021094806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 GROSSMAN DR",
            "city": "BRAINTREE",
            "state": "MA",
            "postal_code": "021844997",
            "telephone_number": "781-849-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTKOVITCH",
        "first_name": "ALONA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-29",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "130542",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "130542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "N365",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "NP1801",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0359840",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Braintree, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.