Active NPI
Ellen Proeung, PA
- Physician Assistant
- Boston, MA
National Provider Identifier
1083019764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA5162
- Practice address
- 75 Francis St
Boston, MA 02115-6110 - Phone
- (617) 632-3206
- NPI assigned
- Oct 24, 2014
- Last updated
- Oct 24, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA5162 | MA | Primary |
Addresses
Primary practice location
75 Francis St
Boston, MA 02115-6110
Mailing address
75 Francis St
Boston, MA 02115-6110
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA5162 | MA | MD | Physician Assistant |
Interoperability endpoints
- eproeung33862@direct.bostonchildrens.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1414108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414108800000",
"number": "1083019764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 FRANCIS ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021156110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 FRANCIS ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021156110",
"telephone_number": "617-632-3206"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROEUNG",
"first_name": "ELLEN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-10-24",
"last_updated": "2014-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MA",
"license": "PA5162",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.