NPIMap

Individual provider Active NPI

Victoria A Coburn, MD

  • Emergency Medicine Physician
  • Boston, MA
National Provider Identifier
1053586669
Registry record updated Jun 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
225551 Issued in MA
Practice address
1 Boston Medical Ctr PL
BCD 1
Boston, MA 02118-2908
Phone
(617) 414-7757
Fax
(617) 414-7759
NPI assigned
Apr 24, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 225551 MA Primary

Addresses

Primary practice location

1 Boston Medical Ctr PL
BCD 1
Boston, MA 02118-2908

Mailing address

960 Massachusetts Avenue
FL 2
Boston, MA 02118-2690

Other identifiers 2

IdentifierTypeStateIssuer
110084083AMedicaidMA
3123868MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091028000187 MA Practitioner - Emergency Medicine 4385781194 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Boston University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boston Emergency Physician Foundation IncGroup PAC ID 4981596095, 74 clinicians

Practice addresses (Care Compare)

1 Boston Medical Ctr PL
Boston, MA 02118-2908
Phone (617) 414-5481

Hospital & facility affiliations

  • Boston Medical Center Hospital, Boston, MA, CCN 220031

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
225551MAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Medical Center Corporation Current Accepting new patients
Boston Emergency Physician Foundation, Inc. Emergency Medicine CurrentSince Sep 1, 2009 Accepting new patients
Boston Medical Center Corporation Past Accepting new patients

Locations

1 Boston Medical Ctr Pl
#1
Boston, MA 02118
Phone (617) 414-4929

960 Massachusetts Ave
Ste 2
Boston, MA 02118

1 Boston Medical Ctr Pl
Roxbury, MA 02118
Phone (617) 414-5245

720 Harrison Ave
#503
Roxbury, MA 02118
Phone 6174145404 ext. 2

Interoperability endpoints

  • Direct secure messaging: vcoburn72867@direct.bmc.masshiway.net

Organizations & group practices 3

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1053586669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVENUE",
            "address_2": "FL 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BOSTON MEDICAL CTR PL",
            "address_2": "BCD 1",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182908",
            "telephone_number": "617-414-7757",
            "fax_number": "617-414-7759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COBURN",
        "first_name": "VICTORIA",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-24",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MA",
            "license": "225551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110084083A",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3123868",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.