NPIMap

Individual provider Active NPI

Ewald Ray Mendeszoon Jr., DPM

  • Foot Surgery Podiatrist
  • Boston, MA
National Provider Identifier
1528031952
Registry record updated Sep 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
2092 Issued in MA
Practice address
732 Harrison Avenue
Preston 5TH Floor
Boston, MA 02118
Phone
(617) 414-6840
Fax
(617) 414-6710
NPI assigned
Feb 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 2092 MA
Foot Surgery Podiatrist 213ES0131X 2092 MA Primary

Addresses

Primary practice location

732 Harrison Avenue
Preston 5TH Floor
Boston, MA 02118

Mailing address

720 Harrison Ave
Dob 503
Boston, MA 02118-2371

Other identifiers 1

IdentifierTypeStateIssuer
110013015AMedicaidMA

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
I20040303000436 MA Practitioner - Podiatry 0547157653 Reassigns benefits to 1 organization
Practice locations: West Roxbury, MA

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
New York College of Podiatric Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boston University General Surgical Associates, Inc.Group PAC ID 9830183763, 86 clinicians

Practice addresses (Care Compare)

732 Harrison Ave
FL 5
Boston, MA 02118-2309
Phone (617) 638-6840

Hospital & facility affiliations

  • Boston Medical Center Hospital, Boston, MA, CCN 220031

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue67
Removal of nail tissue85
Removal or shaving of skin growth30

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Medical Center Corporation Current Accepting new patients
Boston University General Surgical Associates, Inc.-QMC Podiatrist CurrentSince Aug 1, 2013 Accepting new patients
Boston University General Surgical Associates, Inc. Podiatrist CurrentSince Aug 1, 2013 Accepting new patients

Locations

720 Harrison Ave
Ste 700
Boston, MA 02118
Phone (617) 638-8488

732 Harrison Ave
Fl 5
Boston, MA 02118
Phone (617) 414-6840

720 Harrison Ave
#503
Roxbury, MA 02118
Phone 6174145404 ext. 2

Interoperability endpoints

  • Direct secure messaging: emendeszoon188707@direct.ochin.org
  • Direct secure messaging: emendeszoon169546@direct.ochin.org
  • Direct secure messaging: emendeszoon47947@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.

Hospital & facility affiliations 8

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": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506556800000",
    "number": "1528031952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 HARRISON AVE",
            "address_2": "DOB 503",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "732 HARRISON AVENUE",
            "address_2": "PRESTON 5TH FLOOR",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02118",
            "telephone_number": "617-414-6840",
            "fax_number": "617-414-6710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDESZOON",
        "first_name": "EWALD",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2017-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MA",
            "license": "2092",
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "MA",
            "license": "2092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110013015A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.