Individual provider Active NPI

Stephen A. Cannistra, M.D.

  • Medical Oncology Physician
  • Boston, MA
National Provider Identifier
1174552780
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
License
49464 Issued in MA
Practice address
330 Brookline Ave
Beth Israel Deaconess Medical Center
Boston, MA 02215-5400
Phone
(617) 667-4283
NPI assigned
Jul 3, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology Physician 207RX0202X 49464 MA Primary

Addresses

Primary practice location

330 Brookline Ave
Beth Israel Deaconess Medical Center
Boston, MA 02215-5400

Mailing address

631 Greendale Ave
Needham, MA 02492-4336

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
I20050331001111 MA Practitioner - Internal MedicinePractitioner - Medical Oncology 7911954045 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Jun 20, 2010 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Jun 20, 2010 Accepting new patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince Jun 20, 2010 Accepting new patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince Jun 20, 2010 Accepting new patients
Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Ce Past Accepting new patients

Locations

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174552780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 GREENDALE AVE",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024924336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 BROOKLINE AVE",
            "address_2": "BETH ISRAEL DEACONESS MEDICAL CENTER",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022155400",
            "telephone_number": "617-667-4283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNISTRA",
        "first_name": "STEPHEN",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "MA",
            "license": "49464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.