NPIMap

Organization Active NPI

Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc

  • Emergency Medicine Physician
  • Boston, MA
National Provider Identifier
1316987993
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
HARVARD MEDICAL FACULTY PHYS AT BETH ISRAEL DEACONESS MED CTR INC
Practice address
330 Brookline Ave
Boston, MA 02215
Phone
(617) 632-7441
Fax
(617) 754-2350
NPI assigned
Jun 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

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

Authorized official

Name
Dr. Alexandra Boer Kimball, MDNPI 1073503603
Title
Chief Executive Officer
Phone
(617) 632-7441

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

330 Brookline Ave
Boston, MA 02215

Mailing address

375 Longwood Ave Ste 3
Boston, MA 02215-5395
Phone (617) 632-7441

Other identifiers 1

IdentifierTypeStateIssuer
9704591MedicaidMA

Other names 1

  • Emergency Medicine - HMFP at BIDMC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040105000227 MA Part B Supplier - Clinic/Group Practice 4486567104 Receives reassigned benefits from 278 practitioners
Practice locations: Boston, MA; Needham, MA; Dedham, MA

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Ce29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

Locations

330 Brookline Ave
#203
Boston, MA 02215
Phone (617) 667-3364

1340 Boylston St
Fl 4
Boston, MA 02215

1 Brookline Ave
Ste 105
Boston, MA 02215
Phone (616) 278-8000

330 Brookline Ave
Ofc
Boston, MA 02215
Phone (617) 667-4195

1 Deaconess Rd
Fl 2
Boston, MA 02215
Phone (617) 754-2320

1 Brookline Ave
Ste 230
Boston, MA 02215

114 North Beacon St
Ste 116
Brighton, MA 02135

25 Boylston St
Ste 204
Chestnut Hill, MA 02467
Phone (617) 232-8777

200 Boylston St
Chestnut Hill, MA 02467
Phone (617) 278-8640

25 Boylston St
Ste 212
Chestnut Hill, MA 02467
Phone (617) 738-6592

40 Allied Dr
Ste 100
Dedham, MA 02026

115 Lincoln St
#3
Framingham, MA 01702
Phone (508) 383-1436

57 Bedford St
Lexington, MA 02420
Phone (781) 541-5111

21 Highland Ave
Ste 2
Newburyport, MA 01950
Phone (978) 463-7770

15 Roche Brothers Way
Ste 110
North Easton, MA 02356
Phone (781) 792-6500

Practitioners & affiliated clinicians

Practitioners 3,199

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 3,199

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732147200000",
    "number": "1316987993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 LONGWOOD AVE STE 3",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022155395",
            "telephone_number": "617-632-7441",
            "fax_number": "617-632-7570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 BROOKLINE AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02215",
            "telephone_number": "617-632-7441",
            "fax_number": "617-754-2350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARVARD MEDICAL FACULTY PHYS AT BETH ISRAEL DEACONESS MED CTR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A",
        "authorized_official_last_name": "KIMBALL",
        "authorized_official_first_name": "ALEXANDRA",
        "authorized_official_middle_name": "BOER",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "617-632-7441",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9704591",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emergency Medicine - HMFP at BIDMC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Emergency Medicine - HMFP at BIDMC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.