NPIMap

Organization Active NPI

Boston Food Allergy Center LLC

  • Gastroenterology Physician
  • Boston, MA
National Provider Identifier
1386019503
Registry record updated Jul 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
230907 Issued in MA
Legal business name
BOSTON FOOD ALLERGY CENTER LLC
Practice address
65 Harrison Ave Ste 201
Boston, MA 02111-1924
Phone
(617) 636-8858
Fax
(617) 636-8826
NPI assigned
Dec 14, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2022

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

Authorized official

Name
Shaun White
Title
Credentialing Manager
Phone
(502) 244-9859

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X 230907 MA Primary

Addresses

Primary practice location

65 Harrison Ave Ste 201
Boston, MA 02111-1924

Mailing address

1 Nassau Street Unit 1906
Boston, MA 02111-1587
Phone (617) 636-8858

Other identifiers 2

IdentifierTypeStateIssuer
110085164AMedicaidMA
230907OtherMASTATE LICENSE

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1450051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1386019503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 NASSAU STREET UNIT 1906",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021111587",
            "telephone_number": "617-636-8858",
            "fax_number": "617-804-6767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 HARRISON AVE STE 201",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021111924",
            "telephone_number": "617-636-8858",
            "fax_number": "617-636-8826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON FOOD ALLERGY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-14",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "502-244-9859"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MA",
            "license": "230907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110085164A",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "230907",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jul 18, 2022; 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.