NPIMap

Individual provider Active NPI

Blake Laurens Rosenbaum, MD

  • Psychiatry Physician
  • Boston, MA
National Provider Identifier
1053871871
Registry record updated Mar 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
290869 Issued in MA
Practice address
55 Fruit St
Boston, MA 02114-2621
Phone
(617) 548-1553
NPI assigned
Mar 20, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X 290869 MA Primary

Addresses

Primary practice location

55 Fruit St
Boston, MA 02114-2621

Mailing address

229 Freeman St Apt 2
Brookline, MA 02446-6796

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230505001465 MA Practitioner - Psychiatry 5799015608 Reassigns benefits to 4 organizations
I20240621001313 NY Practitioner - Psychiatry 5799015608 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

16 TH St and 1St Ave
New York, NY 10003-3804
Phone (212) 420-2000

301 E 17TH St
New York, NY 10003-3804
Phone (212) 263-7300

530 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

550 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

560 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

Hospital & facility affiliations

  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The General Hospital Corporation CurrentSince Jul 1, 2023 Accepting new patients
The McLean Hospital Corporation Psychiatry CurrentSince Jul 1, 2023 Accepting new patients
New York University CurrentSince Jul 1, 2024 Accepting new patients
New York University CurrentSince Jul 1, 2024 Accepting new patients
Mass General Brigham Medical Group Suburban Massachusetts Inc CurrentSince Jan 24, 2023 Accepting new patients
Massachusetts General Physicians Organization Inc Psychiatry CurrentSince Jul 1, 2023 Accepting new patients

Locations

115 Mill St
Belmont, MA 02478
Phone (617) 855-2000

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

2014 Washington St
Newtonville, MA 02462
Phone (617) 243-6000

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: brosenbaum667104@nyumc.direct-ci.com

Organizations & group practices 6

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 7

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": "1553040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677974400000",
    "number": "1053871871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 FREEMAN ST APT 2",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024466796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-548-1553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENBAUM",
        "first_name": "BLAKE",
        "middle_name": "LAURENS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-20",
        "last_updated": "2023-03-05",
        "certification_date": "2023-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "290869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.