NPIMap

Individual provider Active NPI

Ika Noviawaty, M.D.

  • Epilepsy Physician
  • Boston, MA
National Provider Identifier
1265675292
Registry record updated Jul 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Epilepsy PhysicianTaxonomy code 2084E0001X
License
265068 Issued in MA
Practice address
725 Albany Street, Suite 7B
Shapiro Building
Boston, MA 02118
Phone
(617) 638-8456
Fax
(617) 638-8465
NPI assigned
Apr 6, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neurophysiology Physician 2084N0600X 265068 MA
Epilepsy Physician 2084E0001X 265068 MA Primary
Neurology Physician 2084N0400X 265068 MA

Addresses

Primary practice location

725 Albany Street, Suite 7B
Shapiro Building
Boston, MA 02118

Mailing address

960 Massachusetts Avenue
FL 2
Boston, MA 02118

Other identifiers 2

IdentifierTypeStateIssuer
3104891MedicaidNH
110108436AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160203002159 MA Practitioner - Neurology 3375847890 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
EpileptologistsAlso: Neurology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Boston University Neurology Associates IncGroup PAC ID 6608772462, 60 clinicians

Practice addresses (Care Compare)

725 Albany St
Suite 7B
Boston, MA 02118-3549
Phone (617) 638-8456

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
265068MAMDClinical Neurophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Medical Center Corporation Current Accepting new patients
Umass Memorial Medical Group, Inc. CurrentSince Dec 17, 2015 Accepting new patients
Umass Memorial Medical Group Inc CurrentSince Dec 17, 2015 Accepting new patients
Boston University Neurology Associates, Inc. Neurology CurrentSince Jul 10, 2023 Accepting new patients

Locations

725 Albany St
Ste 7B
Boston, MA 02118
Phone (617) 638-7490

725 Albany St
Ste 7
Boston, MA 02118
Phone (617) 638-8456

960 Massachusetts Ave
Ste 2
Boston, MA 02118

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

Interoperability endpoints

  • Direct secure messaging: inoviawaty236269@direct.bmc.masshiway.net

Organizations & group practices 4

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1238976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1265675292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVENUE",
            "address_2": "FL 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 ALBANY STREET, SUITE 7B",
            "address_2": "SHAPIRO BUILDING",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02118",
            "telephone_number": "617-638-8456",
            "fax_number": "617-638-8465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOVIAWATY",
        "first_name": "IKA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-06",
        "last_updated": "2024-07-08",
        "certification_date": "2023-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "MA",
            "license": "265068",
            "primary": false
        },
        {
            "code": "2084E0001X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Epilepsy",
            "state": "MA",
            "license": "265068",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MA",
            "license": "265068",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3104891",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110108436A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.