Active NPI
Ivy Lynn Brackup, MD
- Family Medicine Physician
- Dorchester, MA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 15530
- Practice address
- 1353 Dorchester Ave
Dorchester, MA 02122-2932 - Phone
- (617) 288-3230
- NPI assigned
- Mar 1, 2006
- Last updated
- Sep 11, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 15530 | MA | Primary |
Addresses
Primary practice location
1353 Dorchester Ave
Dorchester, MA 02122-2932
Mailing address
1353 Dorchester Ave
Dorchester, MA 02122-2932
Phone (617) 288-3230
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3177190 | Medicaid | MA |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1353 Dorchester Ave
Dorchester, MA 02122-2932
Phone (617) 288-3230
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15530 | MA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marino Foundation for Integrative Medicine, Inc. | Family Medicine | Past | Accepting new patients |
| Mass General Brigham Medical Group Suburban Massachusetts Inc | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- ibrackup86328@direct.bmc.masshiway.net
Organizations & group practices 3
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.
-
dba DotHouse Health
- Community Health Clinic/Center
- Dorchester, MA
- NPI 1578514733
-
dba The Marino Center for Integrative Health
- Psychologist
- Cambridge, MA
- NPI 1477662237
Family Medicine
-
- Family Medicine Physician
- Newton, MA
- NPI 1538191218
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Transitional Care Center and Stabilization Care Center
- General Acute Care Hospital
- Boston, MA
- NPI 1164177028
-
dba South Boston Community Health Center
- Community Health Clinic/Center
- South Boston, MA
- NPI 1225228679
Hospital
-
- General Acute Care Hospital
- Boston, MA
- NPI 1346218294
-
dba Greater Roslindale Medical and Dental Center
- Community Health Clinic/Center
- Roslindale, MA
- NPI 1386718823
Hospital
-
dba Dorchester House Multi Service Center
- Community Health Clinic/Center
- Dorchester, MA
- NPI 1780874677
Hospital
-
dba East Boston Neighborhood Health Center
- Community Health Clinic/Center
- East Boston, MA
- NPI 1861683518
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726012800000",
"number": "1184691891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1353 DORCHESTER AVE",
"city": "DORCHESTER",
"state": "MA",
"postal_code": "021222932",
"telephone_number": "617-288-3230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1353 DORCHESTER AVE",
"city": "DORCHESTER",
"state": "MA",
"postal_code": "021222932",
"telephone_number": "617-288-3230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRACKUP",
"first_name": "IVY",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-01",
"last_updated": "2024-09-11",
"certification_date": "2024-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MA",
"license": "15530",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3177190",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dorchester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.