NPIMap

Individual provider Active NPI

Alla Tandetnik, MD

  • Internal Medicine Physician
  • Brookline, MA
National Provider Identifier
1508895673
Registry record updated Jun 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
152738 Issued in MA
Practice address
1180 Beacon St FL 8
Brookline, MA 02446-3885
Phone
(617) 734-2433
Fax
(617) 277-9821
NPI assigned
Jul 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 152738 MA Primary

Addresses

Primary practice location

1180 Beacon St FL 8
Brookline, MA 02446-3885

Mailing address

1180 Beacon St FL 8
Brookline, MA 02446-3885
Phone (617) 734-2433

Other identifiers 1

IdentifierTypeStateIssuer
3166091MedicaidMA

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
I20100909000522 MA Practitioner - Internal Medicine 7618092099 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medical Care of Boston Management CorporationGroup PAC ID 6800787714, 293 clinicians

Practice addresses (Care Compare)

1180 Beacon St
Brookline, MA 02446-3885

93 Pond St
Sharon, MA 02067-2015
Phone (781) 784-9212

Hospital & facility affiliations

  • Central Home Health Care, Inc Home health agency, Needham, MA, CCN 227532
  • Suburban Home Health Care, Inc Home health agency, Boston, MA, CCN 227290
  • Hebrew Seniorlife - Home Health Care Home health agency, Dedham, MA, CCN 227422
  • Vna Care Network Home health agency, Worcester, MA, CCN 227098
  • Mass General Brigham Home Care, Inc Home health agency, Newton, MA, CCN 227207
  • Beth Israel Deaconess Medical Center Hospital, Boston, MA, CCN 220086
  • Beth Israel Deaconess Hospital - Needham Hospital, Needham, MA, CCN 220083
  • Brigham and Women'S Hospital Hospital, Boston, MA, CCN 220110
  • Brigham and Women Faulkner Hospital Hospital, Jamaica Plain, MA, CCN 220119
  • Beth Israel Deaconess Hospital - Milton Hospital, Milton, MA, CCN 220108

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
152738MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Care of Boston Management Corporation Internal Medicine CurrentSince Feb 14, 1997 Accepting new patients

Locations

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

1180 Beacon St
Fl 8
Brookline, MA 02446
Phone (617) 734-2433

93 Pond St
Sharon, MA 02067
Phone (781) 784-9212

Interoperability endpoints

  • Direct secure messaging: atandetnik254408@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.

Hospital & facility affiliations 10

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": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308268800000",
    "number": "1508895673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 BEACON ST FL 8",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024463885",
            "telephone_number": "617-734-2433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 BEACON ST FL 8",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024463885",
            "telephone_number": "617-734-2433",
            "fax_number": "617-277-9821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANDETNIK",
        "first_name": "ALLA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-01",
        "last_updated": "2011-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "152738",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3166091",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookline, MA

Sources for this page

Verify at the official NPI Registry.