Individual provider Active NPI

Sid H. Mondell, PH.D.

  • Clinical Psychologist
  • Boston, MA
National Provider Identifier
1083693246
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2694 Issued in MA
Practice address
1 Boston PL Ste 2600
Boston, MA 02108-4420
Phone
(617) 338-9533
Fax
(857) 239-8801
NPI assigned
Jan 15, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 2694 MA Primary

Addresses

Primary practice location

1 Boston PL Ste 2600
Boston, MA 02108-4420

Mailing address

1 Boston PL Ste 2600
Boston, MA 02108-4420
Phone (617) 338-9533

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080614000010 MA Practitioner - Clinical Psychologist 4284705526 Reassigns benefits to 2 organizations
Practice locations: Boston, MA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

294 Washington St
Suite 415
Boston, MA 02108-4618
Phone (617) 338-9533

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2694MAMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
The General Hospital Corporation CurrentSince Mar 22, 2017 Accepting new patients
Massachusetts General Physicians Organization Inc CurrentSince Mar 22, 2017 Accepting new patients
General Hospital Corp Current Accepting new patients

Locations

55 Fruit St
Boston, MA 02114

294 Washington St
Ste 415
Boston, MA 02108
Phone (617) 338-9533

294 Washington St
Ste 434
Boston, MA 02108
Phone (617) 338-9533

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

Interoperability endpoints

  • Direct secure messaging: mondell.sidney.mgh@direct.partners.masshiway.net

Organizations & group practices 3

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": "1137283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1083693246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BOSTON PL STE 2600",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021084420",
            "telephone_number": "617-338-9533",
            "fax_number": "617-726-3514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BOSTON PL STE 2600",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021084420",
            "telephone_number": "617-338-9533",
            "fax_number": "857-239-8801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONDELL",
        "first_name": "SID",
        "middle_name": "H.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-15",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "2694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.