Individual provider Active NPI

Teresa Linda Vanderboom, MS, ANP-BC

  • Nurse Practitioner
  • Boston, MA
National Provider Identifier
1326289414
Registry record updated Mar 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN246872 Issued in MA
Practice address
55 Fruit St
Gray 241
Boston, MA 02114-2621
Phone
(617) 726-1767
Fax
(617) 726-3089
NPI assigned
Mar 18, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN246872 MA Primary

Addresses

Primary practice location

55 Fruit St
Gray 241
Boston, MA 02114-2621

Mailing address

PO Box 9142
Mass General Physicians Organization Inc.
Charlestown, MA 02129-9142
Phone (617) 724-0287

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
I20090428000230 MA Practitioner - Nurse Practitioner 4082762208 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Massachusetts Medical School, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Massachusetts General Physicians Organization Inc CurrentSince Mar 19, 2009 Accepting new patients
The General Hospital Corporation CurrentSince Jul 1, 2016 Accepting new patients

Locations

55 Fruit St
#241
Boston, MA 02114
Phone (617) 726-1611

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

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.

Hospital & facility affiliations 1

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": "1237334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237334400000",
    "number": "1326289414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9142",
            "address_2": "MASS GENERAL PHYSICIANS ORGANIZATION INC.",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021299142",
            "telephone_number": "617-724-0287",
            "fax_number": "617-726-2894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "address_2": "GRAY 241",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-726-1767",
            "fax_number": "617-726-3089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERBOOM",
        "first_name": "TERESA",
        "middle_name": "LINDA",
        "credential": "MS, ANP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-18",
        "last_updated": "2009-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN246872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.