Tina Boucher Reilly, RD, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

621 Issued in MA

Practice address

1200 Centre St
Roslindale, MA 02131-1011

Phone

(617) 363-8241

NPI assigned

Dec 15, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1639526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1407515653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CENTRE ST",
            "city": "ROSLINDALE",
            "state": "MA",
            "postal_code": "021311011",
            "telephone_number": "617-363-8241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 CENTRE ST",
            "city": "ROSLINDALE",
            "state": "MA",
            "postal_code": "021311011",
            "telephone_number": "617-363-8241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REILLY",
        "first_name": "TINA",
        "middle_name": "BOUCHER",
        "name_prefix": "Ms.",
        "credential": "RD, LDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-15",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": "710263",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MA",
            "license": "621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF REGISTRATION OF DIETITIANS AND NUTRITIONISTS",
            "identifier": "621",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMISSION ON DIETETIC REGISTRATION",
            "identifier": "710263",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Marie Reed, PA-C
• Cynthia Reeves
• Emily Regier, MD
• Jonathan Regis
• Jennifer Ann Reilly, O.D.
• Reis Acupuncture and Wellness
• Resil Medical Associates PC
• Veronica Reyes
• Romina Rezaian, DDS
• Kathleen Rice, MS ED

• Registered Dietitian in Roslindale, MA
• Providers in Roslindale, MA by specialty
• Registered Dietitian in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; 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.