Eileen Frances McCormack, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

198380 Issued in MA

Practice address

1400 VFW Pkwy
West Roxbury, MA 02132-4927

Phone

(857) 203-6151

NPI assigned

Apr 10, 2009

Last updated

Apr 10, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1239321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239321600000",
    "number": "1538302286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 MOON COMPASS LN",
            "city": "SANDWICH",
            "state": "MA",
            "postal_code": "025632766",
            "telephone_number": "617-462-6011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 VFW PKWY",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021324927",
            "telephone_number": "857-203-6151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMACK",
        "first_name": "EILEEN",
        "middle_name": "FRANCES",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-10",
        "last_updated": "2009-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "198380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADULT NURSE PRACTITIONER",
            "identifier": "2005008271-21",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ingrid Elise Mattson-Charnley, PH.D.
• Connor Jeffrey Maxim
• Beth Amy Mayer, LICSW
• Barbara Jean McCollough
• Tanya Noel McCord, M.ED.
• Deirdre Marie McCue, RRT
• Amy McDonough, PHARMD
• Donna J McDonough, CRNA
• Bethany Victoria McEleney, DPT
• Erin Michelle McGarry, N.P.

• Adult Health Nurse Practitioner in West Roxbury, MA
• Providers in West Roxbury, MA by specialty
• Adult Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2009; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.