Active NPI
Hildred B Pennoyer, M.D.
- Internal Medicine Physician
- Boston, MA
National Provider Identifier
1083650592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 70598
- Practice address
- 133 Brookline Ave
Internal Medicine
Boston, MA 02215-3904 - Phone
- (617) 421-5804
- Fax
- (617) 421-8865
- NPI assigned
- Jun 22, 2006
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 70598 | MA | Primary |
Addresses
Primary practice location
133 Brookline Ave
Internal Medicine
Boston, MA 02215-3904
Mailing address
147 Milk St
Provider Enrollment - 9TH Floor
Boston, MA 02109-4806
Phone (617) 559-8374
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PV290 | Other | MA | HARVARD PILGRIM |
| J13617 | Other | MA | BLUE CROSS |
| 467259 | Other | MA | TUFTS |
| 0015265 | Other | MA | NEIGHBORHOOD HEATLH |
| 3190650 | Medicaid | MA |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 70598 | MA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307491200000",
"number": "1083650592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "147 MILK ST",
"address_2": "PROVIDER ENROLLMENT - 9TH FLOOR",
"city": "BOSTON",
"state": "MA",
"postal_code": "021094806",
"telephone_number": "617-559-8374"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "133 BROOKLINE AVE",
"address_2": "INTERNAL MEDICINE",
"city": "BOSTON",
"state": "MA",
"postal_code": "022153904",
"telephone_number": "617-421-5804",
"fax_number": "617-421-8865"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNOYER",
"first_name": "HILDRED",
"middle_name": "B",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-22",
"last_updated": "2011-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "70598",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "PV290",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "J13617",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "467259",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEIGHBORHOOD HEATLH",
"identifier": "0015265",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3190650",
"state": "MA"
}
],
"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 Jun 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.