Individual provider Active NPI

Nicole Carville-Autry, N.P.

  • Adult Health Nurse Practitioner
  • Boston, MA
National Provider Identifier
1427239912
Registry record updated Apr 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
2007005182-21 Issued in MA
Practice address
30 Northampton St
Boston, MA 02118-4098
Phone
(617) 433-9601
Fax
(617) 445-6538
NPI assigned
Nov 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 2007005182-21 MA Primary
Adult Health Nurse Practitioner 363LA2200X 255984RN MA
Gerontology Nurse Practitioner 363LG0600X 2007006045-23 MA

Addresses

Primary practice location

30 Northampton St
Boston, MA 02118-4098

Mailing address

73 Mount Wayte Ave Ste 4
Framingham, MA 01702-5803
Phone (508) 250-0770

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
I20200608001733 MA Practitioner - Nurse Practitioner 2769803360 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Massachusetts Medical School, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bostons Community Medical Group IncGroup PAC ID 1355390691, 31 clinicians

Practice addresses (Care Compare)

30 Northampton St
Boston, MA 02118-4098
Phone (617) 433-9601

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2007005182-21MAMDAdult Health Nurse Practitioner
255984RNMAMDAdult Health Nurse Practitioner
2007006045-23MAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Boston'S Community Medical Group, Inc. CurrentSince Mar 1, 2020 Accepting new patients

Locations

30 Northampton St
Roxbury, MA 02118
Phone (617) 433-9601

3550 Main St
Ste 101
Springfield, MA 01107
Phone (413) 739-0669

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1196035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1427239912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73 MOUNT WAYTE AVE STE 4",
            "city": "FRAMINGHAM",
            "state": "MA",
            "postal_code": "017025803",
            "telephone_number": "508-250-0770",
            "fax_number": "617-457-3135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 NORTHAMPTON ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021184098",
            "telephone_number": "617-433-9601",
            "fax_number": "617-445-6538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARVILLE-AUTRY",
        "first_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-26",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "2007005182-21",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "255984RN",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MA",
            "license": "2007006045-23",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.