Individual provider Active NPI

Israel Tadesse Woldeyesus, MD

  • Student in an Organized Health Care Education/Training Program
  • Boston, MA
National Provider Identifier
1518769082
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
670 Albany St Ste 3
Boston, MA 02118-2653
Phone
(617) 414-5314
Fax
(617) 414-5315
NPI assigned
Mar 26, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

670 Albany St Ste 3
Boston, MA 02118-2653

Mailing address

670 Albany St Ste 3
Boston, MA 02118-2653
Phone (617) 414-5314

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250916002796 MA Order and Referring Only - PathologyPractitioner - Pathology 4284138025

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Medical Center Corporation Current Accepting new patients
Boston University Mallory Pathology Associates, Inc. PastSince Mar 30, 2025 Accepting new patients
Evans Medical Foundation, Inc. PastSince Mar 30, 2025 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: iwoldeyesus255905@direct.bmc.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1742947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742947200000",
    "number": "1518769082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 ALBANY ST STE 3",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182653",
            "telephone_number": "617-414-5314",
            "fax_number": "617-414-5315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 ALBANY ST STE 3",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182653",
            "telephone_number": "617-414-5314",
            "fax_number": "617-414-5315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLDEYESUS",
        "first_name": "ISRAEL",
        "middle_name": "TADESSE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-26",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.