Active NPI
Tim Niyogusaba
- Student in an Organized Health Care Education/Training Program
- Boston, MA
National Provider Identifier
1407524697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 15 Parkman St
Boston, MA 02114-3117 - Phone
- (781) 485-1000
- Fax
- (781) 286-5418
- NPI assigned
- Sep 1, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | GA | Primary |
Addresses
Primary practice location
15 Parkman St
Boston, MA 02114-3117
Mailing address
15 Parkman St
Boston, MA 02114-3117
Phone (781) 485-1000
Other practice location 1
201 Dowman Dr NE
Atlanta, GA 30322-1061
Phone (404) 727-6123
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230623000255 | MA | Order and Referring Only - Internal Medicine | 6406214477 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686182400000",
"number": "1407524697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 PARKMAN ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021143117",
"telephone_number": "781-485-1000",
"fax_number": "781-286-5418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 PARKMAN ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021143117",
"telephone_number": "781-485-1000",
"fax_number": "781-286-5418"
}
],
"practiceLocations": [
{
"address_1": "201 Dowman Dr NE",
"address_purpose": "LOCATION",
"city": "Atlanta",
"state": "GA",
"postal_code": "303221061",
"country_code": "US",
"telephone_number": "404-727-6123",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NIYOGUSABA",
"first_name": "TIM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-01",
"last_updated": "2023-06-08",
"certification_date": "2023-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "GA",
"license": null,
"primary": true
}
],
"identifiers": [],
"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 Jun 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.