Active NPI
Robert Frederick Nace, PSY.D., M.DIV.
- Clinical Psychologist
- Hyde Park, MA
National Provider Identifier
1063586451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 8042
- Practice address
- 17 Winslow St
Hyde Park, MA 02136-1730 - Phone
- (617) 240-6713
- NPI assigned
- Nov 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 8042 | MA | Primary |
Addresses
Primary practice location
17 Winslow St
Hyde Park, MA 02136-1730
Mailing address
17 Winslow St
Hyde Park, MA 02136-1730
Phone (617) 361-4563
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1857258 | Other | MA | MASSHEALTH |
| W06259 | Other | MA | BLUECROSSBLUESHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040805001342 | MA | Practitioner - Clinical Psychologist | 2062483506 | Practice locations: Cambridge, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1280 Massachusetts Ave
Cambridge, MA 02138-3827
Phone (617) 240-6713
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728259200000",
"number": "1063586451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 WINSLOW ST",
"city": "HYDE PARK",
"state": "MA",
"postal_code": "021361730",
"telephone_number": "617-361-4563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 WINSLOW ST",
"city": "HYDE PARK",
"state": "MA",
"postal_code": "021361730",
"telephone_number": "617-240-6713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NACE",
"first_name": "ROBERT",
"middle_name": "FREDERICK",
"name_prefix": "Dr.",
"credential": "PSY.D., M.DIV.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2024-10-07",
"certification_date": "2024-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "8042",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASSHEALTH",
"identifier": "1857258",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSSBLUESHIELD",
"identifier": "W06259",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hyde Park, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.