Active NPI
Brad Shattuck, D.O.
- Psychiatry Physician
- Boston, MA
National Provider Identifier
1598029084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 261480
- Practice address
- 800 Boylston St.
16TH Floor
Boston, MA 02199 - Phone
- (857) 288-8342
- Fax
- (888) 160-5204
- NPI assigned
- Jun 28, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 252801 | MA | |
| Psychiatry Physician | 2084P0800X | 261480 | MA | Primary |
Addresses
Primary practice location
800 Boylston St.
16TH Floor
Boston, MA 02199
Mailing address
800 Boylston St.
16TH Floor
Boston, MA 02199
Phone (857) 288-8342
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 252801 | MA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518048000000",
"number": "1598029084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 BOYLSTON ST.",
"address_2": "16TH FLOOR",
"city": "BOSTON",
"state": "MA",
"postal_code": "02199",
"telephone_number": "857-288-8342",
"fax_number": "888-160-5204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 BOYLSTON ST.",
"address_2": "16TH FLOOR",
"city": "BOSTON",
"state": "MA",
"postal_code": "02199",
"telephone_number": "857-288-8342",
"fax_number": "888-160-5204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHATTUCK",
"first_name": "BRAD",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-28",
"last_updated": "2018-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MA",
"license": "252801",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MA",
"license": "261480",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.