Individual provider Active NPI

Patrick D Mabray

  • Neurology with Special Qualifications in Child Neurology Physician
  • Boston, MA
National Provider Identifier
1265790810
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
270418 Issued in MA
Practice address
725 Albany Street
Shapiro 8
Boston, MA 02118
Phone
(617) 414-4841
NPI assigned
May 1, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 270418 MA
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 270418 MA Primary

Addresses

Primary practice location

725 Albany Street
Shapiro 8
Boston, MA 02118

Mailing address

BMC Provider Enrollment Office
960 Massachusetts Ave,.2ND Floor
Boston, MA 02118
Phone (617) 414-5405

Other practice location 1

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 793-5647

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address pmabray245723@UmassMemorial.direct-ci.com
FHIR URL https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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
I20170905003081 MA Practitioner - NeurologyPractitioner - Pediatric Medicine 0042583544 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Pediatric Medicine
Education
Boston University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Child Health Foundation of Boston IncGroup PAC ID 1557263340, 27 clinicians

Practice addresses (Care Compare)

725 Albany St
Boston, MA 02118-2526
Phone 61741448413

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
270418MAMDNeurology with Special Qualifications in Child Neurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Medical Center Corporation Current Accepting new patients
Child Health Foundation of Boston, Inc. Pediatrics CurrentSince Aug 1, 2017 Accepting new patients

Locations

960 Massachusetts Ave
Ste 2
Boston, MA 02118

850 Harrison Ave
#4
Boston, MA 02118
Phone (617) 414-2000

725 Albany St
#8
Boston, MA 02118
Phone (617) 414-4841

720 Harrison Ave
#503
Roxbury, MA 02118
Phone 6174145404 ext. 2

Interoperability endpoints

  • Direct secure messaging: pmabray245723@umassmemorial.direct-ci.com
  • Direct secure messaging: pmabray99551@direct.bmc.masshiway.net

Organizations & group practices 2

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": "1335830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712275200000",
    "number": "1265790810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BMC PROVIDER ENROLLMENT OFFICE",
            "address_2": "960 MASSACHUSETTS AVE,.2ND FLOOR",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02118",
            "telephone_number": "617-414-5405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 ALBANY STREET",
            "address_2": "SHAPIRO 8",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02118",
            "telephone_number": "617-414-4841"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Lake Ave N",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016550002",
            "country_code": "US",
            "telephone_number": "508-793-5647",
            "fax_number": "508-856-4287",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MABRAY",
        "first_name": "PATRICK",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-01",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "270418",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "MA",
            "license": "270418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pmabray245723@UmassMemorial.direct-ci.com",
            "affiliation": "N",
            "address_1": "55 Lake Ave N",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016550002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "55 Lake Ave N",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016550002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.