Individual provider Active NPI

Ateev Mehrotra, MD

  • Internal Medicine Physician
  • Boston, MA
National Provider Identifier
1245221654
Registry record updated Feb 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
205042 Issued in MA
Practice address
330 Brookline Ave # Span2
Boston, MA 02215-5400
Phone
(617) 754-4677
Fax
(617) 632-0215
NPI assigned
Nov 3, 2005
Last updated
Feb 21, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 205042 MA Primary
Pediatrics Physician 208000000X 205042 MA

Addresses

Primary practice location

330 Brookline Ave # Span2
Boston, MA 02215-5400

Mailing address

330 Brookline Ave # Span2
Boston, MA 02215-5400
Phone (617) 754-4677

Other identifiers 3

IdentifierTypeStateIssuer
469258OtherMATUFTS HEALTH PLAN
J28161OtherMABCBS MA
2070821MedicaidMA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040816000203 MA Practitioner - Internal MedicinePractitioner - Pediatric Medicine 8628041084 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
205042MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc Internal Medicine CurrentSince Aug 5, 2013 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Aug 5, 2013 Accepting new patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is Internal Medicine CurrentSince Jan 1, 2015 Accepting new patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince Aug 5, 2013 Accepting new patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince Aug 5, 2013 Accepting new patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is CurrentSince Jan 1, 2015 Accepting new patients

Locations

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

330 Brookline Ave
#2
Boston, MA 02215
Phone (617) 632-8383

199 Reedsdale Rd
Milton, MA 02186
Phone (617) 313-1000

275 Sandwich St
Plymouth, MA 02360
Phone (508) 746-2000

1 University Ave
Westwood, MA 02090
Phone (617) 754-1021

Organizations & group practices 6

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487635200000",
    "number": "1245221654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 BROOKLINE AVE # SPAN2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022155400",
            "telephone_number": "617-754-4677",
            "fax_number": "617-632-0215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 BROOKLINE AVE # SPAN2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022155400",
            "telephone_number": "617-754-4677",
            "fax_number": "617-632-0215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHROTRA",
        "first_name": "ATEEV",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2017-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "205042",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "205042",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "469258",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MA",
            "identifier": "J28161",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2070821",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.