Individual provider Active NPI

Larissa Azevedo Depina, NP

  • Nurse Practitioner
  • Brockton, MA
National Provider Identifier
1215495452
Registry record updated Mar 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN2267945 Issued in MA
Practice address
635 Summer St
Brockton, MA 02302-4230
Phone
(508) 631-5532
NPI assigned
Mar 6, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN2267945 MA Primary

Addresses

Primary practice location

635 Summer St
Brockton, MA 02302-4230

Mailing address

635 Summer St
Brockton, MA 02302-4230
Phone (508) 631-5532

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
I20190509001266 MA Practitioner - Nurse Practitioner 9234472424 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN2267945MAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Matrix Medical Plus Nurse Practitioner CurrentSince Sep 1, 2022 Accepting new patients
Signify Health Medical Associates, PLLC Nurse Practitioner CurrentSince Nov 29, 2022 Accepting new patients

Locations

9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883

155 Federal St
Ste 700
Boston, MA 02110
Phone (469) 466-7420

3 Allied Dr
Dedham, MA 02026
Phone (404) 587-0945

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

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": "1551830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551830400000",
    "number": "1215495452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 SUMMER ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023024230",
            "telephone_number": "508-631-5532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 SUMMER ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023024230",
            "telephone_number": "508-631-5532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEPINA",
        "first_name": "LARISSA",
        "middle_name": "AZEVEDO",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-06",
        "last_updated": "2019-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN2267945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.