NPIMap

Individual provider Active NPI

Sudipta Mohanty, MD

  • Internal Medicine Physician
  • Boston, MA
National Provider Identifier
1447663695
Registry record updated Nov 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
277029 Issued in MA
Practice address
330 Brookline Ave
Boston, MA 02215
Phone
(617) 754-9600
Fax
(951) 486-5705
NPI assigned
Jun 5, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A141308 CA
Internal Medicine Physician 207R00000X 277029 MA Primary

Addresses

Primary practice location

330 Brookline Ave
Boston, MA 02215

Mailing address

330 Brookline Ave
Boston, MA 02215-5400
Phone (617) 754-9600

Other practice location 1

26520 Cactus Ave
Moreno Valley, CA 92555-3927
Phone (951) 486-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, MA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170927003122 CA Practitioner - Internal Medicine 5496029506 Reassigns benefits to 1 organization
I20181018001365 MA Practitioner - Internal Medicine 5496029506 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

330 Brookline Ave
Boston, MA 02215-5400
Phone (617) 754-8612

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A141308CAMDInternal Medicine Physician
277029MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince Sep 13, 2018 Accepting new patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince Sep 13, 2018 Accepting new patients
Riverside Faculty Medical Group Inc Internal Medicine CurrentSince Aug 2, 2017 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Sep 13, 2018 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc Internal Medicine CurrentSince Sep 13, 2018 Accepting new patients

Locations

26520 Cactus Ave
Moreno Valley, CA 92555
Phone (951) 486-5610

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

Organizations & group practices 5

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 11

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": "1401926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543363200000",
    "number": "1447663695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 BROOKLINE AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022155400",
            "telephone_number": "617-754-9600",
            "fax_number": "951-486-5705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 BROOKLINE AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02215",
            "telephone_number": "617-754-9600",
            "fax_number": "951-486-5705"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "26520 Cactus Ave",
            "address_purpose": "LOCATION",
            "city": "Moreno Valley",
            "state": "CA",
            "postal_code": "925553927",
            "country_code": "US",
            "telephone_number": "951-486-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOHANTY",
        "first_name": "SUDIPTA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-05",
        "last_updated": "2018-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A141308",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "277029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.