Individual provider Active NPI

Desiree Tavarez, PNP

  • Pediatric Nurse Practitioner
  • Braintree, MA
National Provider Identifier
1255089090
Registry record updated Mar 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
RN2341137 Issued in MA
Practice address
111 Grossman Dr
Braintree, MA 02184-4997
Phone
(781) 849-2300
NPI assigned
Mar 11, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X RN2341137 MA Primary

Addresses

Primary practice location

111 Grossman Dr
Braintree, MA 02184-4997

Mailing address

111 Grossman Dr
Braintree, MA 02184-4997

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
I20220606002201 MA Practitioner - Nurse Practitioner 6608254529 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN2341137MAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Atrius Health, Inc. CurrentSince Jun 1, 2022 Accepting new patients
Brigham & Womens Hospital, Inc. CurrentSince Nov 1, 2022 Accepting new patients
Atrius Health, Inc. Current Accepting new patients
Atrius Health, Inc. CurrentSince Jun 1, 2022 Accepting new patients
Brigham & Womens Physicians Organization Inc CurrentSince Nov 1, 2022 Accepting new patients

Locations

147 Milk St
Fl 9
Boston, MA 02109
Phone (617) 559-8051

75 Francis St
Boston, MA 02115

133 Brookline Ave
Boston, MA 02215
Phone (617) 421-1000

111 Grossman Dr
Braintree, MA 02184
Phone (781) 849-1000

1153 Centre St
Jamaica Plain, MA 02130
Phone (617) 983-7000

399 Revolution Dr
Somerville, MA 02145
Phone (800) 856-1983

Interoperability endpoints

  • Direct secure messaging: tavarez.desiree.bwh@direct.partners.masshiway.net

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1646956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646956800000",
    "number": "1255089090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 GROSSMAN DR",
            "city": "BRAINTREE",
            "state": "MA",
            "postal_code": "021844997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 GROSSMAN DR",
            "city": "BRAINTREE",
            "state": "MA",
            "postal_code": "021844997",
            "telephone_number": "781-849-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVAREZ",
        "first_name": "DESIREE",
        "name_prefix": "Mrs.",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-11",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MA",
            "license": "RN2341137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Braintree, MA

Sources for this page

Verify at the official NPI Registry.