NPIMap

Individual provider Active NPI

Evgenia Forman, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Dorchester Center, MA
National Provider Identifier
1215042361
Registry record updated Mar 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
228097 Issued in MA
Practice address
2216 Dorchester Ave
Dorchester Center, MA 02124-5607
Phone
(617) 296-5100
NPI assigned
Aug 20, 2006
Last updated
Mar 25, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 228097 MA Primary

Addresses

Primary practice location

2216 Dorchester Ave
Dorchester Center, MA 02124-5607

Mailing address

2216 Dorchester Ave
Dorchester Center, MA 02124-5607

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070106000113 MA Practitioner - Geriatric Medicine 5890795371 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Care of Boston Management CorporationGroup PAC ID 6800787714, 293 clinicians

Practice addresses (Care Compare)

93 Pond St
Sharon, MA 02067-2015
Phone (781) 784-9212

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
228097MAMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Care of Boston Management Corporation CurrentSince Jul 31, 2006 Accepting new patients
Caritas Medical Group, Inc. Past Accepting new patients
Sherrill House, Inc Past Accepting new patients
Harbor Health Services, Inc. Past Accepting new patients
Park, Marion and Vernon Streets Operating Company, LLC Past Accepting new patients

Locations

100 Highland St
Ste 105
Milton, MA 02186
Phone (617) 696-1460

93 Pond St
Sharon, MA 02067
Phone (781) 784-9212

Interoperability endpoints

  • Direct secure messaging: eforman155476@direct.bilh.masshiway.net

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
ClaCCN 225201 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 2009
Jul 1, 2009
Legacy Lifecare Hospice and Palliative CareChelsea, MA, CCN 221584 Hospice Contracted Managing Employee
Operational/Managerial Control
Other		 Mar 23, 2016
Mar 23, 2016
Jan 1, 2020

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

Hospital & facility affiliations 10

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": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206403200000",
    "number": "1215042361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2216 DORCHESTER AVE",
            "city": "DORCHESTER CENTER",
            "state": "MA",
            "postal_code": "021245607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2216 DORCHESTER AVE",
            "city": "DORCHESTER CENTER",
            "state": "MA",
            "postal_code": "021245607",
            "telephone_number": "617-296-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "EVGENIA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-20",
        "last_updated": "2008-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MA",
            "license": "228097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dorchester Center, MA

Sources for this page

Verify at the official NPI Registry.