NPIMap

Organization Active NPI

Toward Independent Living and Learning

Doing business as TILL Medical Group

  • Neurology Physician
  • Dedham, MA
National Provider Identifier
1528294832
Registry record updated Jun 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
73077 Issued in MA
Legal business name
TOWARD INDEPENDENT LIVING AND LEARNING
Doing business as
TILL Medical Group
Practice address
20 Eastbrook Rd
Suite 201
Dedham, MA 02026-2075
Phone
(781) 302-4600
NPI assigned
Jun 2, 2009
Last updated
Jun 2, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2009

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

Authorized official

Name
Dafna Krouk-Gordon
Title
President
Phone
(781) 302-4600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X 73077 MA Primary
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X 199217 MA

Addresses

Primary practice location

20 Eastbrook Rd
Suite 201
Dedham, MA 02026-2075

Mailing address

20 Eastbrook Rd
Suite 201
Dedham, MA 02026-2075
Phone (781) 302-4600

Other names 1

  • TILL Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060215000402 MA Part B Supplier - Clinic/Group Practice 6103831979 Receives reassigned benefits from 15 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dedham, MA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 55

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1243900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243900800000",
    "number": "1528294832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 EASTBROOK RD",
            "address_2": "SUITE 201",
            "city": "DEDHAM",
            "state": "MA",
            "postal_code": "020262075",
            "telephone_number": "781-302-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 EASTBROOK RD",
            "address_2": "SUITE 201",
            "city": "DEDHAM",
            "state": "MA",
            "postal_code": "020262075",
            "telephone_number": "781-302-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOWARD INDEPENDENT LIVING AND LEARNING",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-02",
        "last_updated": "2009-06-02",
        "status": "A",
        "authorized_official_last_name": "KROUK-GORDON",
        "authorized_official_first_name": "DAFNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-302-4600"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MA",
            "license": "73077",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "199217",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TILL Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dedham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.