Individual provider Active NPI

Ana Vaughan-Malloy, M.D.

  • Pediatric Infectious Diseases Physician
  • Boston, MA
National Provider Identifier
1366763062
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Infectious Diseases PhysicianTaxonomy code 2080P0208X
License
274930 Issued in MA
Practice address
300 Longwood Ave
Boston, MA 02115
Phone
(617) 355-6000
NPI assigned
Jun 16, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Infectious Diseases Physician 2080P0208X MT209054 PA
Hospitalist Physician 208M00000X 47885 AZ
Student in an Organized Health Care Education/Training Program 390200000X
Pediatric Infectious Diseases Physician 2080P0208X 274930 MA Primary

Addresses

Primary practice location

300 Longwood Ave
Boston, MA 02115

Mailing address

300 Longwood Ave
Boston, MA 02115-5724
Phone (617) 355-6000

Other identifiers 1

IdentifierTypeStateIssuer
823974MedicaidAZ

Other names 1

  • Ana Vaughan Former name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180828002196 MA Practitioner - Infectious DiseasePractitioner - Pediatric Medicine 8628219813 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MT209054PAMDPediatric Infectious Diseases Physician
47885AZMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Pediatric Associates, Inc Pediatric Infectious Diseases CurrentSince Aug 1, 2018 Accepting new patients

Locations

300 Longwood Ave
Boston, MA 02115
Phone (617) 355-4956

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1276646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1366763062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155724",
            "telephone_number": "617-355-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02115",
            "telephone_number": "617-355-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHAN-MALLOY",
        "first_name": "ANA",
        "name_prefix": "Ms.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-16",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0208X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Infectious Diseases",
            "state": "PA",
            "license": "MT209054",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "AZ",
            "license": "47885",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0208X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Infectious Diseases",
            "state": "MA",
            "license": "274930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "823974",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANA",
            "last_name": "VAUGHAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.