NPIMap

Individual provider Active NPI

Antonio E Bullon, M.D.

  • Psychiatry Physician
  • Cambridge, MA
National Provider Identifier
1063527950
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
152835 Issued in MA
Practice address
330 Mount Auburn St
Cambridge, MA 02138-5502
Phone
(617) 905-7103
Fax
(617) 499-5419
NPI assigned
Aug 20, 2006
Last updated
Apr 3, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 152835 MA Primary
Geriatric Psychiatry Physician 2084P0805X 152835 MA

Addresses

Primary practice location

330 Mount Auburn St
Cambridge, MA 02138-5502

Mailing address

47 School St
Hopkinton, MA 01748-2121
Phone (617) 905-7103

Other practice location 1

955 Massachusetts Ave Ste 185
Cambridge, MA 02139-3180
Phone (617) 905-7103

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
I20090612000173 MA Practitioner - PsychiatryPractitioner - Internal Medicine 8628128683 Reassigns benefits to 3 organizations
Practice locations: Brookline, MA

Care Compare profile

Medicare Care Compare
Specialty
PsychiatryAlso: Internal Medicine
Education
University Central del Caribe Escuela de Medicina, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mount Auburn HospitalGroup PAC ID 2668364183, 8 clinicians

Practice addresses (Care Compare)

330 Mount Auburn St
Cambridge, MA 02138-5502
Phone (617) 499-5054

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc Single Specialty Current Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc Single Specialty CurrentSince Sep 7, 2024 Accepting new patients
Mount Auburn Hospital Single Specialty CurrentSince Jul 19, 2014 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Aug 1, 2025 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc Single Specialty CurrentSince Sep 7, 2024 Accepting new patients

Locations

85 Herrick St
Beverly, MA 01915
Phone (978) 816-3700

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

330 Mount Auburn St
Cambridge, MA 02138
Phone (617) 499-5054

Interoperability endpoints

  • Direct secure messaging: abullon35836@direct.bilh.masshiway.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743638400000",
    "number": "1063527950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 SCHOOL ST",
            "city": "HOPKINTON",
            "state": "MA",
            "postal_code": "017482121",
            "telephone_number": "617-905-7103",
            "fax_number": "617-499-5419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 MOUNT AUBURN ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021385502",
            "telephone_number": "617-905-7103",
            "fax_number": "617-499-5419"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "955 Massachusetts Ave Ste 185",
            "address_purpose": "LOCATION",
            "city": "Cambridge",
            "state": "MA",
            "postal_code": "021393180",
            "country_code": "US",
            "telephone_number": "617-905-7103",
            "fax_number": "617-499-5419",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BULLON",
        "first_name": "ANTONIO",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "152835",
            "primary": true
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "MA",
            "license": "152835",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cambridge, MA

Sources for this page

Verify at the official NPI Registry.