Individual provider Active NPI

Bethany Ann Sanders, CNP

  • Gerontology Nurse Practitioner
  • East Boston, MA
National Provider Identifier
1417308750
Registry record updated Jun 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
RN2296169 Issued in MA
Practice address
10 Gove St
East Boston, MA 02128-1920
Phone
(617) 569-5800
Fax
(617) 568-4780
NPI assigned
Jun 28, 2016
Last updated
Jun 4, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X RN2296169 MA
Gerontology Nurse Practitioner 363LG0600X RN2296169 MA Primary

Addresses

Primary practice location

10 Gove St
East Boston, MA 02128-1920

Mailing address

10 Gove St
East Boston, MA 02128-1920
Phone (617) 569-5800

Other names 1

  • Bethany Ann Crombie Former name

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161129001609 MA Practitioner - Nurse Practitioner 7012297542 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN2296169MAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Associates of Ebnhc Current Accepting new patients
Neighborhealth Corporation CurrentSince Oct 17, 2016 Accepting new patients
Internal Medical Associates-Ebnhc CurrentSince Oct 17, 2016 Accepting new patients

Locations

10 Grove St
East Boston, MA 02128
Phone (617) 569-5800

Interoperability endpoints

  • Direct secure messaging: bsanders8928@direct.neighborhealth.masshiway.net

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1467072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559606400000",
    "number": "1417308750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 GOVE ST",
            "city": "EAST BOSTON",
            "state": "MA",
            "postal_code": "021281920",
            "telephone_number": "617-569-5800",
            "fax_number": "617-568-4780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 GOVE ST",
            "city": "EAST BOSTON",
            "state": "MA",
            "postal_code": "021281920",
            "telephone_number": "617-569-5800",
            "fax_number": "617-568-4780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "BETHANY",
        "middle_name": "ANN",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-28",
        "last_updated": "2019-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "RN2296169",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MA",
            "license": "RN2296169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BETHANY",
            "last_name": "CROMBIE",
            "middle_name": "ANN",
            "credential": "CNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in East Boston, MA

Sources for this page

Verify at the official NPI Registry.