NPIMap

Individual provider Active NPI

Rafael Carmona, DMD

  • Endodontics
  • Roxbury, MA
National Provider Identifier
1588198667
Registry record updated Apr 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
DL13223 Issued in MA
Practice address
1290 Tremont St FL 2
Roxbury, MA 02120-3432
Phone
(617) 989-3229
Fax
(617) 858-2664
NPI assigned
Apr 17, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X DL13223 MA Primary

Addresses

Primary practice location

1290 Tremont St FL 2
Roxbury, MA 02120-3432

Mailing address

1290 Tremont St FL 2
Roxbury, MA 02120-3432
Phone (617) 989-3229

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
I20210602000486 MA Practitioner - Dentist 9931508504 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DL13223MAMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Harbor Health Services, Inc. CurrentSince May 1, 2021 Accepting new patients
Harbor Health Services Inc CurrentSince May 1, 2021 Accepting new patients

Locations

250 Mount Vernon St
Dorchester, MA 02125
Phone (617) 288-1140

1135 Morton St
Mattapan, MA 02126
Phone (617) 533-2300

Interoperability endpoints

  • Direct secure messaging: rcarmona345330@direct.ochin.org

Ownership & related parties

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Greater Lawrence Family Health Center IncLawrence, MA, CCN 221813 Federally qualified health center Corporate Director Feb 7, 2023
Greater Lawrence Family Health Center IncLawrence, MA, CCN 221898 Federally qualified health center Corporate Director Feb 7, 2023
Greater Lawrence Family Health Center IncLawrence, MA, CCN 221897 Federally qualified health center Corporate Director Feb 7, 2023
Greater Lawrence Family Health Center IncAndover, MA, CCN 221899 Federally qualified health center Corporate Director Feb 7, 2023
Greater Lawrence Family Health Center IncLawrence, MA, CCN 221901 Federally qualified health center Corporate Director Feb 7, 2023
Greater Lawrence Family Health Center IncLawrence, MA, CCN 221900 Federally qualified health center Corporate Director Feb 7, 2023
Greater Lawrence Family Health Center IncLawrence, MA, CCN 221908 Federally qualified health center Corporate Director Feb 7, 2023
Greater Lawrence Family Health Center IncMethuen, MA, CCN 221915 Federally qualified health center Corporate Director Feb 7, 2023
Greater Lawrence Family Health Center IncHaverhill, MA, CCN 221955 Federally qualified health center Corporate Director Feb 7, 2023

Owned or controlled facilities with NPI records 9

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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": "1492387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492387200000",
    "number": "1588198667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 TREMONT ST FL 2",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021203432",
            "telephone_number": "617-989-3229",
            "fax_number": "617-858-2664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 TREMONT ST FL 2",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021203432",
            "telephone_number": "617-989-3229",
            "fax_number": "617-858-2664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARMONA",
        "first_name": "RAFAEL",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-17",
        "last_updated": "2017-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MA",
            "license": "DL13223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roxbury, MA

Sources for this page

Verify at the official NPI Registry.