NPIMap

Individual provider Active NPI

Mariusz Olesiak, PA-C

  • Physician Assistant
  • Boston, MA
National Provider Identifier
1417204496
Registry record updated Mar 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA4408 Issued in MA
Practice address
725 Albany St
Shapiro Lower Level
Boston, MA 02118
Phone
(617) 638-6287
Fax
(617) 638-6284
NPI assigned
Aug 9, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA4408 MA Primary

Addresses

Primary practice location

725 Albany St
Shapiro Lower Level
Boston, MA 02118

Mailing address

720 Harrison Ave
Dob 503
Boston, MA 02118-2371

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150903000071 MA Practitioner - Physician Assistant 0244546463 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boston University General Surgical Associates, Inc.Group PAC ID 9830183763, 86 clinicians

Practice addresses (Care Compare)

1 Boston Medical Ctr PL
Boston, MA 02118-2908
Phone (617) 638-8605

732 Harrison Ave
Boston, MA 02118-2309

732 Harrison Ave FL 3
Preston BLDG
Boston, MA 02118-2309
Phone (617) 638-7350

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA4408MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Boston University General Surgical Associates, Inc.-QMC CurrentSince Jul 1, 2015 Accepting new patients
Boston Medical Center Corporation Current Accepting new patients
Afc Physicians of Massachusetts, PC CurrentSince Oct 1, 2017 Accepting new patients

Locations

725 Albany St
Lowr
Boston, MA 02118
Phone (617) 638-6278

732 Harrison Ave
Fl 5
Boston, MA 02118
Phone (617) 414-6840

945 Worcester St
Natick, MA 01760
Phone (508) 650-6208

Interoperability endpoints

  • Direct secure messaging: molesiak12739@direct.bmc.masshiway.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1344470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425427200000",
    "number": "1417204496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 HARRISON AVE",
            "address_2": "DOB 503",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 ALBANY ST",
            "address_2": "SHAPIRO LOWER LEVEL",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02118",
            "telephone_number": "617-638-6287",
            "fax_number": "617-638-6284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLESIAK",
        "first_name": "MARIUSZ",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-09",
        "last_updated": "2015-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA4408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.