Individual provider Active NPI

Juan R Condemarin, MD

  • Addiction Psychiatry Physician
  • Brighton, MA
National Provider Identifier
1083894059
Registry record updated Nov 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Psychiatry PhysicianTaxonomy code 2084P0802X
License
216179 Issued in MA
Practice address
129 Bigelow St
Brighton, MA 02135-1639
Phone
(617) 254-4349
NPI assigned
Nov 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Psychiatry Physician 2084P0802X 216179 MA Primary

Addresses

Primary practice location

129 Bigelow St
Brighton, MA 02135-1639

Mailing address

180 Morton St
Jamaica Plain, MA 02130-3735
Phone (617) 626-9587

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100510000386 MA Practitioner - Psychiatry 1759419971 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Commonwealth of MassachusettsGroup PAC ID 8820906860, 141 clinicians

Practice addresses (Care Compare)

75 Fenwood Rd
Boston, MA 02115-6103
Phone (617) 626-9300

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Commonwealth of Massachusetts Current Accepting new patients
North Suffolk Community Services Inc. PastSince Oct 20, 1997 Accepting new patients

Locations

75 Fenwood Rd
Boston, MA 02115
Phone (617) 626-9300

76 Amory St
Roxbury, MA 02119
Phone (617) 626-9300

Organizations & group practices 2

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": "1194393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194393600000",
    "number": "1083894059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 MORTON ST",
            "city": "JAMAICA PLAIN",
            "state": "MA",
            "postal_code": "021303735",
            "telephone_number": "617-626-9587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 BIGELOW ST",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021351639",
            "telephone_number": "617-254-4349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONDEMARIN",
        "first_name": "JUAN",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-07",
        "last_updated": "2007-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "MA",
            "license": "216179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brighton, MA

Sources for this page

Verify at the official NPI Registry.