Michelle Dalencour, M.D.
Individual provider Active NPI Family Medicine Physician · Mattapan, MA
NPI 1073873006 · NPPES record last updated Jul 18, 2016
Key facts
- NPI
- 1073873006
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 263506 (MA)
- Practice address
- 1575 Blue Hill Ave
Mattapan, MA 02126-2122 - Phone
- (617) 296-0061
- NPI assigned
- May 23, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Emerson Practice Associates, Inc
Practice addresses (Care Compare)
133 Old Rd to 9 Acre Cor
Concord, MA 01742-4159
Phone (978) 287-3020
Hospital & facility affiliations
- Emerson Hospital -
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181214000361 | MA | Practitioner - Family Practice | 4789818287 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emerson Practice Associates, Inc. | Current |
Accepting new patients |
Locations
133 Ornac
Concord, MA 01742
Phone (978) 287-3000
830 Constitution Ave
Littleton, MA 01460
Phone (978) 287-8990
9 Northeastern Blvd
Ste 400
Salem, NH 03079
Interoperability endpoints
- dalencour.michelle.epa@direct.partners.masshiway.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 263506 | MA | Yes |
Addresses
Primary practice location
1575 Blue Hill Ave
Mattapan, MA 02126-2122
Mailing address
1575 Blue Hill Ave
Mattapan, MA 02126-2122
Phone (617) 296-0061
Other providers in Mattapan, MA
- Beverly Cox
- Carol Crawford
- Irene Crofton
- CVS Pharmacy Inc
- D. James Thomas Ministries Inc
- Kristin M Dame
- Tin Dang
- Mina M Daniel
- Margaret Ann Daunt
- Dayspring Dental LLC
All providers in Mattapan, MA · Family Medicine Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.