Individual provider Active NPI

Marcine Logue, NP

  • Family Nurse Practitioner
  • Watertown, MA
National Provider Identifier
1174581029
Registry record updated Mar 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN196221 Issued in MA
Practice address
480 Pleasant St Ste A300
Watertown, MA 02472-2463
Phone
(617) 926-9000
Fax
(617) 926-7053
NPI assigned
May 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN196221 MA Primary

Addresses

Primary practice location

480 Pleasant St Ste A300
Watertown, MA 02472-2463

Mailing address

330 Mt Auburn St
Parsons 2
Cambridge, MA 02138-5597
Phone (617) 926-9000

Other identifiers 2

IdentifierTypeStateIssuer
110014310AMedicaidMA
0327964MedicaidMA

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050629001016 MA Practitioner - Nurse Practitioner 2062458045 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mount Auburn Professional Services IncGroup PAC ID 6103725031, 229 clinicians

Practice addresses (Care Compare)

57 Bedford St
Suite 130
Lexington, MA 02420-4543
Phone (781) 862-7500

Hospital & facility affiliations

  • Mount Auburn Hospital Hospital, Cambridge, MA, CCN 220002

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN196221MAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Auburn Professional Services Inc CurrentSince Feb 24, 2010 Accepting new patients
Mt Auburn Professional Services CurrentSince Feb 24, 2010 Accepting new patients
Mt Auburn Professional Services Past Accepting new patients
Mount Auburn Professional Services Inc PastSince Apr 6, 2025 Accepting new patients

Locations

330 Mount Auburn St
#2
Cambridge, MA 02138
Phone (617) 499-5026

57 Bedford St
Ste 130
Lexington, MA 02420
Phone (781) 484-7500

480 Pleasant St
Ste A300
Watertown, MA 02472
Phone (617) 926-9000

480 Pleasant St
#A300
Watertown, MA 02472
Phone (617) 926-9000

521 Mount Auburn St
Ste 202
Watertown, MA 02472
Phone (617) 926-9000

Interoperability endpoints

  • Direct secure messaging: mlogue490567@direct.bilh.masshiway.net
  • FHIR API: https://api.platform.athenahealth.com/86/brand/1/csg/1/fhir/r4

Organizations & group practices 4

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": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743379200000",
    "number": "1174581029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 MT AUBURN ST",
            "address_2": "PARSONS 2",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021385597",
            "telephone_number": "617-926-9000",
            "fax_number": "617-926-7053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 PLEASANT ST STE A300",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024722463",
            "telephone_number": "617-926-9000",
            "fax_number": "617-926-7053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGUE",
        "first_name": "MARCINE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-02",
        "last_updated": "2025-03-31",
        "certification_date": "2025-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN196221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110014310A",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0327964",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, MA

Sources for this page

Verify at the official NPI Registry.