Justin Eusebio, MSN, RN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN2320812 Issued in MA

Practice address

19 Tacoma St
Worcester, MA 01605-3516

Phone

(508) 595-1115

NPI assigned

Jul 18, 2019

Last updated

Jan 8, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Edward M Kennedy Community Health Center IncGroup PAC ID 3476512740, 65 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Registered Nurse

State licenses

Practice roles

Locations

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.

• Edward M. Kennedy Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Worcester, MA
  • NPI 1609842152
  Medicare reassignment Care Compare group NPD
• Edward M. Kennedy Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Worcester, MA
  • NPI 1316324650
  NPD
• Edward M. Kennedy Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Milford, MA
  • NPI 1992137426
  NPD (past)
• Westborough Behavioral Healthcare Hospital, LLC

  dba Westborough Professional Associates, LLC

  • Psychiatry Physician
  • Westborough, MA
  • NPI 1821565425
  NPD (past)
• Westborough Behavioral Healthcare Hospital, LLC

  dba Westborough Behavioral Healthcare Hospital

  • Psychiatric Hospital
  • Westborough, MA
  • NPI 1861901910
  NPD (past)

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

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578441600000",
    "number": "1073166112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 TACOMA ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016053516",
            "telephone_number": "508-852-1805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 TACOMA ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016053516",
            "telephone_number": "508-595-1115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Friberg Pkwy",
            "address_purpose": "LOCATION",
            "city": "Westborough",
            "state": "MA",
            "postal_code": "015813900",
            "country_code": "US",
            "telephone_number": "508-329-6300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EUSEBIO",
        "first_name": "JUSTIN",
        "name_prefix": "Mr.",
        "credential": "MSN, RN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-18",
        "last_updated": "2020-01-08",
        "certification_date": "2020-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2320812",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2320812",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pius Kwame Etteh
• Eugene J. Mariani, Jr., D.D.S.
• Coby Eure, MD
• Eureka Adult Foster Care LLC
• Euro Transportation, LLC
• Jessica Brooke Eva
• Jaclyn Marie Evangelista, SLP
• Evank Home Healthcare Services
• Leah R. Evans Wong, M.D.
• Harmony Evans

• Psychiatric/Mental Health Nurse Practitioner in Worcester, MA
• Providers in Worcester, MA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2020; 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.

Verify at the official NPI Registry.