Individual provider Active NPI

Adam C Jaroszewski, AM

  • Psychologist
  • Boston, MA
National Provider Identifier
1538627898
Registry record updated May 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY5000220 Issued in MA
Practice address
55 Fruit St
Boston, MA 02114-2621
Phone
(617) 726-6766
NPI assigned
Mar 6, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY5000220 MA Primary
Student in an Organized Health Care Education/Training Program 390200000X MA

Addresses

Primary practice location

55 Fruit St
Boston, MA 02114-2621

Mailing address

1 Constitution PLZ
Home Base Program
Charlestown, MA 02129-2025
Phone (617) 724-5202

Other practice location 1

1 Constitution Plz
Home Base Program
Charlestown, MA 02129-2025
Phone (617) 724-5202

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230531000463 MA Practitioner - Clinical Psychologist 1052778487 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The General Hospital Corporation CurrentSince Jul 1, 2023 Accepting new patients
Massachusetts General Physicians Organization Inc CurrentSince Jul 1, 2023 Accepting new patients

Locations

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

Organizations & group practices 2

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": "1551830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683504000000",
    "number": "1538627898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CONSTITUTION PLZ",
            "address_2": "HOME BASE PROGRAM",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021292025",
            "telephone_number": "617-724-5202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-726-6766"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Constitution Plz",
            "address_2": "Home Base Program",
            "address_purpose": "LOCATION",
            "city": "Charlestown",
            "state": "MA",
            "postal_code": "021292025",
            "country_code": "US",
            "telephone_number": "617-724-5202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAROSZEWSKI",
        "first_name": "ADAM",
        "middle_name": "C",
        "credential": "AM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-06",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "PSY5000220",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.