Individual provider Active NPI

Danielle Rene Bellavance, MD

  • Internal Medicine Physician
  • Boston, MA
National Provider Identifier
1164008173
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
1018064 Issued in MA
Practice address
801 Massachusetts Ave, Suite 6a
Crosstown BLDG
Boston, MA 02118-2605
Phone
(617) 414-5951
Fax
(617) 414-9201
NPI assigned
Mar 20, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 1018064 MA Primary

Addresses

Primary practice location

801 Massachusetts Ave, Suite 6a
Crosstown BLDG
Boston, MA 02118-2605

Mailing address

960 Massachusetts Ave
FL 2
Boston, MA 02118-2690

Other practice location 1

72 E. Newton St
Ste 124
Boston, MA 02118-2308
Phone (617) 638-7253

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
I20240826000410 MA Practitioner - Internal Medicine 7315341799

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1018064MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Evans Medical Foundation, Inc. Internal Medicine CurrentSince Jul 1, 2024 Accepting new patients
Boston Medical Center Corporation Current Accepting new patients

Locations

72 Newton St
Ste 124
Boston, MA 02118
Phone (617) 638-7253

725 Albany St
Boston, MA 02118
Phone (617) 414-4075

88 Newton St
Boston, MA 02118
Phone (617) 638-7350

960 Massachusetts Ave
Ste 2
Boston, MA 02118

1 Boston Medical Ctr Pl
Roxbury, MA 02118
Phone (617) 414-5245

Interoperability endpoints

  • Direct secure messaging: dbellavance140435@direct.bmc.masshiway.net

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": "1616198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1164008173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVE",
            "address_2": "FL 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 MASSACHUSETTS AVE, SUITE 6A",
            "address_2": "CROSSTOWN BLDG",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182605",
            "telephone_number": "617-414-5951",
            "fax_number": "617-414-9201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "72 E. Newton St",
            "address_2": "Ste 124",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021182308",
            "country_code": "US",
            "telephone_number": "617-638-7253",
            "fax_number": "617-638-6501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BELLAVANCE",
        "first_name": "DANIELLE",
        "middle_name": "RENE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-20",
        "last_updated": "2024-05-10",
        "certification_date": "2024-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "1018064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.