Individual provider Active NPI

Elise Lingbo Boventer, MD, MPH

  • Hospitalist Physician
  • New York, NY
National Provider Identifier
1154882108
Registry record updated Aug 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
318424 Issued in NY
Practice address
130 E 77TH St
New York, NY 10075-1851
Phone
(212) 434-4000
NPI assigned
Mar 30, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 31, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 318424 NY
Hospitalist Physician 208M00000X 318424 NY Primary

Addresses

Primary practice location

130 E 77TH St
New York, NY 10075-1851

Mailing address

420 W 25TH St Apt 8a
New York, NY 10001-6553
Phone (978) 905-5581

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20241105002526 NY Practitioner - HospitalistPractitioner - Internal Medicine 2668906280 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Tufts University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

100 E 77TH St
New York, NY 10075-1850
Phone (212) 434-2140

Hospital & facility affiliations

  • Lenox Hill Hospital Hospital, New York, NY, CCN 330119

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
318424NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC Internal Medicine CurrentSince Oct 9, 2024 Accepting new patients
Lenox Hill Hospital Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650

130 E 77th St
New York, NY 10075
Phone (212) 434-2606

100 E 77th St
New York, NY 10075
Phone (212) 434-2606

300 Community Dr
Plandome, NY 11030

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: eboventer66042@northwell.direct-ci.com

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725062400000",
    "number": "1154882108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 W 25TH ST APT 8A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100016553",
            "telephone_number": "978-905-5581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 E 77TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751851",
            "telephone_number": "212-434-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOVENTER",
        "first_name": "ELISE",
        "middle_name": "LINGBO",
        "name_prefix": "Dr.",
        "credential": "MD, MPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-30",
        "last_updated": "2024-08-31",
        "certification_date": "2024-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "318424",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "318424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.