Active NPI
J. Alexander Bodkin, M.D.
- Psychiatry Physician
- Belmont, MA
National Provider Identifier
1235222969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 56622
- Practice address
- 115 Mill Street
Belmont, MA 02478 - Phone
- (617) 855-3186
- Fax
- (617) 855-2936
- NPI assigned
- Oct 2, 2006
- Last updated
- Jul 8, 2007
- 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 | 56622 | MA | Primary |
Addresses
Primary practice location
115 Mill Street
Belmont, MA 02478
Mailing address
115 Mill Street
McLean Hospital
Belmont, MA 02478
Phone (617) 855-3186
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| JO8279 | Other | MA | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56622 | MA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235222969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 MILL STREET",
"address_2": "MCLEAN HOSPITAL",
"city": "BELMONT",
"state": "MA",
"postal_code": "02478",
"telephone_number": "617-855-3186",
"fax_number": "617-855-2936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 MILL STREET",
"city": "BELMONT",
"state": "MA",
"postal_code": "02478",
"telephone_number": "617-855-3186",
"fax_number": "617-855-2936"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODKIN",
"first_name": "J. ALEXANDER",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MA",
"license": "56622",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "JO8279",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Belmont, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.