Boston Food Allergy Center, Steward Healthcare Network

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

230907 Issued in MA

Legal business name

BOSTON FOOD ALLERGY CENTER, STEWARD HEALTHCARE NETWORK

Practice address

65 Harrison Ave
Suite 201
Boston, MA 02111-1924

Phone

(617) 636-8858

Fax

(617) 636-8826

NPI assigned

Jul 27, 2016

Last updated

Jul 27, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shaun White

Title

Credentialing Manager

Phone

(502) 244-9859

Specialties & licenses 2

Addresses

Other identifiers 3

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

{
    "created_epoch": "1469577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469577600000",
    "number": "1023561966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 NASSAU ST",
            "address_2": "UNIT 1906",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021111542",
            "telephone_number": "617-636-8858",
            "fax_number": "617-636-8826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 HARRISON AVE",
            "address_2": "SUITE 201",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021111924",
            "telephone_number": "617-636-8858",
            "fax_number": "617-636-8826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON FOOD ALLERGY CENTER, STEWARD HEALTHCARE NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-27",
        "last_updated": "2016-07-27",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "502-244-9859"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "MA",
            "license": "230907",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MA",
            "license": "230907",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110109748A",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER LICENSE",
            "identifier": "230907",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110085164A - INDIV",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Boston Eye Surgery & Laser Center Trust (Boston Eye Surgery & Laser Center)
• Boston Eyewear
• Boston Food Allergy Center
• Boston Food Allergy Center LLC
• Boston Food Allergy Center LLC Bi Network
• Boston Health Care for the Homeless Program, Inc.
• Boston Health Care for the Homeless Program, Inc. (McInnis Health Group)
• Boston Health Care for the Homeless Program, Inc.
• Boston Health Care for the Homeless Program, Inc.
• Boston Health Care for the Homeless Program, Inc. (BHCHP Pharmacy)

• Allergy & Immunology Physician in Boston, MA
• Providers in Boston, MA by specialty
• Allergy & Immunology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2016; 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.