Individual provider Active NPI

Cheryl Depalo A Jost, OD

  • Optometrist
  • Cambridge, MA
National Provider Identifier
1083719371
Registry record updated Aug 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4351 Issued in MA
Practice address
1 Porter SQ
Cambridge, MA 02140-1431
Phone
(617) 864-7005
NPI assigned
Sep 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4351 MA Primary

Addresses

Primary practice location

1 Porter SQ
Cambridge, MA 02140-1431

Mailing address

350 Myles Standish Blvd
Suite 201
Taunton, MA 02780-7387
Phone (508) 823-9307

Other identifiers 5

IdentifierTypeStateIssuer
AA3300OtherMAHARVARD PILGRIM
W22057OtherMABLUE CROSS BLUE SHIELD
468669OtherMATUFTS
3398327OtherMAAETNA
4351OtherMALICENSE NUMBER

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041102000181 MA Practitioner - Optometry 2961464938 Reassigns benefits to 1 organization
Practice locations: Boston, MA; Cambridge, MA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jeffrey Kublin OD PCGroup PAC ID 9537216361, 5 clinicians

Practice addresses (Care Compare)

175 Cambridge St
Boston, MA 02114-2743
Phone (617) 523-7006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Jeffrey Kublin OD, PC Optometrist CurrentSince Aug 11, 2015 Accepting new patients
Northern Star Dental Group Past Accepting new patients
Leslie K Carey OD LLC Optometrist Past Accepting new patients
Pro Optical Optometrist Past Accepting new patients

Locations

175 Cambridge St
Fl 4
Boston, MA 02114
Phone (617) 643-1230

175 Cambridge St
Ste 130
Boston, MA 02114

175 Cambridge St
Boston, MA 02114
Phone (617) 523-7006

Organizations & group practices 4

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": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440633600000",
    "number": "1083719371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 MYLES STANDISH BLVD",
            "address_2": "SUITE 201",
            "city": "TAUNTON",
            "state": "MA",
            "postal_code": "027807387",
            "telephone_number": "508-823-9307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PORTER SQ",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021401431",
            "telephone_number": "617-864-7005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOST",
        "first_name": "CHERYL DEPALO",
        "middle_name": "A",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2015-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "AA3300",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "W22057",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "468669",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "3398327",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "4351",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cambridge, MA

Sources for this page

Verify at the official NPI Registry.