Active NPI
Patrick Vavken
- Sports Medicine (Orthopaedic Surgery) Physician
- Boston, MA
National Provider Identifier
1295151520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Orthopaedic Surgery) Physician
- License
- 1
- Practice address
- 300 Longwood Ave
Enders 260
Boston, MA 02114 - Phone
- (617) 919-2105
- NPI assigned
- Mar 11, 2014
- Last updated
- Mar 11, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 2 | ZZ | |
| Sports Medicine (Orthopaedic Surgery) Physician | 207XX0005X | 1 | ZZ | Primary |
Addresses
Primary practice location
300 Longwood Ave
Enders 260
Boston, MA 02114
Mailing address
4 Emerson Place
Apt 604
Boston, MA 02115
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2 | ZZ | MD | Orthopaedic Surgery Physician |
| 1 | ZZ | MD | Sports Medicine (Orthopaedic Surgery) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1394496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394496000000",
"number": "1295151520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 EMERSON PLACE",
"address_2": "APT 604",
"city": "BOSTON",
"state": "MA",
"postal_code": "02115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 LONGWOOD AVE",
"address_2": "ENDERS 260",
"city": "BOSTON",
"state": "MA",
"postal_code": "02114",
"telephone_number": "617-919-2105"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAVKEN",
"first_name": "PATRICK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-03-11",
"last_updated": "2014-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "ZZ",
"license": "2",
"primary": false
},
{
"code": "207XX0005X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Sports Medicine",
"state": "ZZ",
"license": "1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.