Active NPI
Mark Randolph Elin, PH.D.
- Clinical Neuropsychologist
- Longmeadow, MA
National Provider Identifier
1366460891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 4026
- Practice address
- 1200 Converse St
Suite 102
Longmeadow, MA 01106-1760 - Phone
- (413) 567-9244
- NPI assigned
- Jul 17, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 4026 | MA | Primary |
Addresses
Primary practice location
1200 Converse St
Suite 102
Longmeadow, MA 01106-1760
Mailing address
1200 Converse St
Suite 102
Longmeadow, MA 01106-1760
Phone (413) 567-9244
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0522589 | Medicaid | MA |
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070521000111 | MA | Practitioner - Clinical Psychologist | 1355448770 | Practice locations: Longmeadow, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Yale University School of Medicine, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1200 Converse St
Suite 102
Longmeadow, MA 01106-1760
Phone (413) 567-9244
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4026 | MA | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366460891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 CONVERSE ST",
"address_2": "SUITE 102",
"city": "LONGMEADOW",
"state": "MA",
"postal_code": "011061760",
"telephone_number": "413-567-9244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 CONVERSE ST",
"address_2": "SUITE 102",
"city": "LONGMEADOW",
"state": "MA",
"postal_code": "011061760",
"telephone_number": "413-567-9244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELIN",
"first_name": "MARK",
"middle_name": "RANDOLPH",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "MA",
"license": "4026",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0522589",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longmeadow, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.