Elisabeth Joan Moths-Rebrovic, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

58102 Issued in MA

Practice address

415 Columbia Rd
Dorchester, MA 02125-2424

Phone

(617) 287-8000

Fax

(617) 740-8070

NPI assigned

Jan 30, 2006

Last updated

Jan 13, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Upham's Corner Health Committee, Inc.

  dba Upham's Corner Health Center

  • Community Health Clinic/Center
  • Dorchester, MA
  • NPI 1780780486
  Medicare reassignment NPD
• Uphams Corner Health Committee Inc

  dba Upham's Home Health Care

  • Home Health Agency
  • Dorchester, MA
  • NPI 1932285624
  NPD (past)

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326412800000",
    "number": "1558332270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 COLUMBIA RD",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021252424",
            "telephone_number": "617-287-8000",
            "fax_number": "617-740-8070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 COLUMBIA RD",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021252424",
            "telephone_number": "617-287-8000",
            "fax_number": "617-740-8070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOTHS-REBROVIC",
        "first_name": "ELISABETH",
        "middle_name": "JOAN",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-30",
        "last_updated": "2012-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "58102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3083101",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tanya Morrissey, LPN
• Anita Mortley
• Caitlin Morton
• Maryanne Beth Moses
• Marcela Mota Aversa
• Marjan Mottaghi
• Moving Forward Physical Therapy Boston, Inc
• Alisa Rochelle Muhammad
• Fard Muhammad
• Destinee Mulcahy, MSCJ, LADCI

• Family Medicine Physician in Dorchester, MA
• Providers in Dorchester, MA by specialty
• Family Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2012; 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.