Individual provider Active NPI

Elizabeth Ann Barkoudah, M.D.

  • Neurology with Special Qualifications in Child Neurology Physician
  • Boston, MA
National Provider Identifier
1063614352
Registry record updated Apr 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
231486 Issued in MA
Practice address
300 Longwood Ave
Fegan 11
Boston, MA 02115-5724
Phone
(617) 355-6388
NPI assigned
May 31, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 231486 MA
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 231486 MA Primary
Pediatric Neurodevelopmental Disabilities Physician 2080P0008X 231486 MA

Addresses

Primary practice location

300 Longwood Ave
Fegan 11
Boston, MA 02115-5724

Mailing address

11 Grovenor Rd
Apt 3
Jamaica Plain, MA 02130-2515
Phone (617) 435-9108

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110912000049 MA Practitioner - NeurologyPractitioner - Pediatric Medicine 5092986687 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Pediatric Medicine
Education
University of Nebraska College of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
C H Neurology Foundation IncGroup PAC ID 5496744195, 56 clinicians

Practice addresses (Care Compare)

300 Longwood Ave
Boston, MA 02115-5724
Phone (617) 355-6000

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
C H Neurology Foundation Inc Pediatrics CurrentSince Jul 6, 2011 Accepting new patients

Locations

300 Longwood Ave
Boston, MA 02115
Phone (617) 355-4956

300 Longwood Ave
#11
Boston, MA 02115
Phone (617) 355-6388

Interoperability endpoints

  • Direct secure messaging: ebarkoudah66129@direct.bostonchildrens.org

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397433600000",
    "number": "1063614352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 GROVENOR RD",
            "address_2": "APT 3",
            "city": "JAMAICA PLAIN",
            "state": "MA",
            "postal_code": "021302515",
            "telephone_number": "617-435-9108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "address_2": "FEGAN 11",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155724",
            "telephone_number": "617-355-6388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARKOUDAH",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-31",
        "last_updated": "2014-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "231486",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "MA",
            "license": "231486",
            "primary": true
        },
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "MA",
            "license": "231486",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.