Form Health Associates Ma, P.C.

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

Legal business name

FORM HEALTH ASSOCIATES MA, P.C.

Practice address

109 State Street
5TH FL
Boston, MA 02109-2906

Phone

(617) 505-1520

Fax

(617) 928-8401

NPI assigned

Jun 23, 2020

Last updated

Mar 18, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nam H Kim, MDNPI 1942506472

Title

President

Phone

(617) 505-1520

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA, TX, IL, NY, PA, VA, CO7 enrollments

Enrollment records 7

Locations

Practitioners 109

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alyshia Marie Casella, FNP-BC

  • Family Nurse Practitioner
  • Boston, MA
  • NPI 1972074136
  Medicare reassignment Care Compare group NPD
• Florencia Halperin, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Boston, MA
  • NPI 1083804926
  Medicare reassignment Care Compare group NPD
• Priya P. Joshi, M.D.

  • Internal Medicine Physician
  • Boston, MA
  • NPI 1619138302

  TX

  Medicare reassignment Care Compare group NPD
• Catherine Putko, NP

  • Family Nurse Practitioner
  • Boston, MA
  • NPI 1922657907
  Medicare reassignment Care Compare group NPD
• Kaleigh Silva, FNP

  • Family Nurse Practitioner
  • Boston, MA
  • NPI 1356062004
  Medicare reassignment Care Compare group NPD
• Angela M Simpson, MD

  • Internal Medicine Physician
  • Fall River, MA
  • NPI 1699723700
  Medicare reassignment Care Compare group NPD
• Lara Enid Smith, MD

  • Family Medicine Physician
  • Boston, MA
  • NPI 1215386800

  IL

  Medicare reassignment Care Compare group NPD
• Robert Ander, MD

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1588051122
  Medicare reassignment Care Compare group NPD
• Dominique Duncan, FNP-C

  • Family Nurse Practitioner
  • New York, NY
  • NPI 1255757464
  Medicare reassignment Care Compare group NPD
• Tracy Elder, APRN

  • Family Nurse Practitioner
  • Cleburne, TX
  • NPI 1437705522
  Medicare reassignment Care Compare group NPD
• Susan Falotico, RPA-C

  • Physician Assistant
  • New York, NY
  • NPI 1225522402
  Medicare reassignment Care Compare group NPD
• Janis E Freeman, FNP-C

  • Family Nurse Practitioner
  • New York, NY
  • NPI 1730493214
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1592870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773792000000",
    "number": "1386260594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 STATE ST",
            "address_2": "5TH FL",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021092906",
            "telephone_number": "617-505-1520",
            "fax_number": "617-928-8401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 STATE STREET",
            "address_2": "5TH FL",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021092906",
            "telephone_number": "617-505-1520",
            "fax_number": "617-928-8401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORM HEALTH ASSOCIATES MA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-23",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "NAM",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-505-1520",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glynn K Forkey, LCSW
• Shannon Nicole Forlivio, PA-C
• Steven Forlivio, PA
• Form Behavioral Health Services PA
• Form Health Associates Ma, P.C.
• Form Psychiatry PLLC
• Alexandra Beth Forman, MD
• Ellen Forman
• John P Forman, MD
• Malka Leah Forman

• Endocrinology, Diabetes & Metabolism Physician in Boston, MA
• Providers in Boston, MA by specialty
• Endocrinology, Diabetes & Metabolism Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.