Active NPI
Allan Nineberg, MD
- Psychiatry Physician
- Cambridge, MA
National Provider Identifier
1215980271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 46107
- Practice address
- 307 Concord Ave
Cambridge, MA 02138-1207 - Phone
- (617) 497-1484
- NPI assigned
- May 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 46107 | MA | Primary |
Addresses
Primary practice location
307 Concord Ave
Cambridge, MA 02138-1207
Mailing address
307 Concord Ave
Cambridge, MA 02138-1207
Phone (617) 497-1484
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0144789 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 3, 2022 through Mar 3, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268265600000",
"number": "1215980271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "307 CONCORD AVE",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021381207",
"telephone_number": "617-497-1484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "307 CONCORD AVE",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021381207",
"telephone_number": "617-497-1484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NINEBERG",
"first_name": "ALLAN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-18",
"last_updated": "2010-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MA",
"license": "46107",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0144789",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.