Breakwater Anesthesia, Inc.

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

Legal business name

BREAKWATER ANESTHESIA, INC.

Practice address

900 Cummings Ctr Ste 117T
Beverly, MA 01915-6183

Phone

(617) 922-5655

NPI assigned

Nov 4, 2018

Organization subpart

No

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

Authorized official

Name

Jacob Bevilacqua, CRNA

Title

Co-Owner

Phone

(617) 922-5655

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1541289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546905600000",
    "number": "1356819791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 ELWELL ST UNIT 2",
            "city": "GLOUCESTER",
            "state": "MA",
            "postal_code": "019302905",
            "telephone_number": "617-922-5655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 CUMMINGS CTR STE 117T",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156183",
            "telephone_number": "617-922-5655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAKWATER ANESTHESIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-04",
        "last_updated": "2019-01-08",
        "status": "A",
        "authorized_official_last_name": "BEVILACQUA",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "617-922-5655",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI - JACOB BEVILACQUA",
            "identifier": "1992048870",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI  - PATRICK KEATING",
            "identifier": "1679916142",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scott Braid
• Kristin Renee Bramante, MS, CMHC
• Alexandra Brann
• Nicole Branum
• Richard Brea
• Leslie Jane Brennan, LICSW
• Mary Brennan
• Thomas Edward Brennan Jr.
• John Brennenstuhl
• Fiona Mary Breslin, MD

• Certified Registered Nurse Anesthetist in Beverly, MA
• Providers in Beverly, MA by specialty
• Certified Registered Nurse Anesthetist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.