Active NPI
Yana Antonellis, N.P.
- Nurse Practitioner
- Jamaica Plain, MA
National Provider Identifier
1497744981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 233109
- Practice address
- 545A Centre St
Jamaica Plain, MA 02130-2061 - Phone
- (617) 522-5464
- Fax
- (617) 524-2966
- NPI assigned
- Oct 18, 2005
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 233109 | MA | Primary |
Addresses
Primary practice location
545A Centre St
Jamaica Plain, MA 02130-2061
Mailing address
545A Centre St
Jamaica Plain, MA 02130-2061
Phone (617) 522-5464
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0322580 | Medicaid | MA |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
545 A Centre St
Jamaica Plain, MA 02130-2061
Phone (617) 522-5464
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 233109 | MA | MD | Pharmacist |
Interoperability endpoints
- yantonellis164113@direct.bilh.masshiway.net
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Needham, MA
- NPI 1437196359
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210723200000",
"number": "1497744981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "545A CENTRE ST",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021302061",
"telephone_number": "617-522-5464",
"fax_number": "617-524-2966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "545A CENTRE ST",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021302061",
"telephone_number": "617-522-5464",
"fax_number": "617-524-2966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTONELLIS",
"first_name": "YANA",
"credential": "N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-18",
"last_updated": "2008-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MA",
"license": "233109",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0322580",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jamaica Plain, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.