NPIMap

Organization Active NPI

Lifestyle Medical and Cardiovascular Associates PC

  • Cardiovascular Disease Physician
  • Chestnut Hill, MA
National Provider Identifier
1396356556
Registry record updated Aug 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
LIFESTYLE MEDICAL AND CARDIOVASCULAR ASSOCIATES PC
Practice address
300 Boylston St Ste 201
Chestnut Hill, MA 02467-1978
Phone
(617) 916-9433
NPI assigned
Aug 12, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2020

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

Authorized official

Name
Kimberly Parks, DONPI 1861686230
Title
Owner
Phone
(617) 678-8857

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

300 Boylston St Ste 201
Chestnut Hill, MA 02467-1978

Mailing address

20 Thompson Rd
Branford, CT 06405-2842
Phone (203) 489-0808

Other names 1

  • Synergy Private Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201120000669 MA Part B Supplier - Clinic/Group Practice 0941611016 Receives reassigned benefits from 7 practitioners
Practice locations: Wellesley, MA

National Provider Directory

National Provider Directory

Locations

20 Thompson Rd
Branford, CT 06405

300 Boylston St
Ste 201
Chestnut Hill, MA 02467
Phone (617) 831-7100

112 Worcester St
Wellesley, MA 02481

112 Worcester St
Ste 303
Wellesley Hills, MA 02481
Phone (617) 916-9433

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597190400000",
    "number": "1396356556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 THOMPSON RD",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064052842",
            "telephone_number": "203-489-0808",
            "fax_number": "877-403-8633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 BOYLSTON ST STE 201",
            "city": "CHESTNUT HILL",
            "state": "MA",
            "postal_code": "024671978",
            "telephone_number": "617-916-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTYLE MEDICAL AND CARDIOVASCULAR ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-12",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-678-8857",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Synergy Private Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chestnut Hill, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; 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.