Cynthia J Agudosi
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Brockton, MA
NPI 1104605310 · NPPES record last updated Sep 26, 2023
Key facts
- NPI
- 1104605310
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 2023101879 (MA)
- Practice address
- 409 Spring St
Brockton, MA 02301-3632 - Phone
- (774) 281-3646
- NPI assigned
- Sep 26, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- South Shore Mental Health Center Inc
Practice addresses (Care Compare)
460 Quincy Ave
Quincy, MA 02169-8130
Phone (617) 847-1950
Merit-based Incentive Payment System (MIPS)
- Final score
- 86.67 of 100
- Quality
- 71.18
- Improvement activities
- 40
- Cost
- 75.07
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231206004389 | MA | Practitioner - Nurse Practitioner | 2163871898 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2023101879 | MA | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Supportive Behavioral Care of Ma LLC | Current |
Accepting new patients | |
| South Shore Mental Health Center, Inc. | Current |
Accepting new patients |
Locations
44 School St
Rm 325
Boston, MA 02108
Phone (508) 831-8558
1501 Washington St
Braintree, MA 02184
Phone (617) 745-2709
460 Quincy Ave
Quincy, MA 02169
Phone (617) 770-4000
27 Randolph Rd
Howell, NJ 07731
Phone (972) 677-7951
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 2023101879 | MA | Yes |
Addresses
Primary practice location
409 Spring St
Brockton, MA 02301-3632
Mailing address
409 Spring St
Brockton, MA 02301-3632
Phone (774) 281-3646
Other providers in Brockton, MA
- Agape Adult Day Health Center
- Agape Wellness and Home Care
- Shobhit Agarwal
- Chikwendu Agomoh
- Amy Agrawal
- Katie Coral Aguilar Mendoza
- Jordan Aguirre
- Patricia Jean Ahearn.Burnett
- Maham Ahmad
- Fadwa Ahmed
All providers in Brockton, MA · Psychiatric/Mental Health Nurse Practitioner in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.