Individual provider Active NPI

Andrew L Glick, MD MPH

  • Internal Medicine Physician
  • Boston, MA
National Provider Identifier
1609335900
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
292362 Issued in MA
Practice address
801 Massachusetts Ave
Crosstown 2
Boston, MA 02118-0211
Phone
(617) 414-7399
Fax
(617) 414-4676
NPI assigned
Mar 16, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 292362 MA Primary

Addresses

Primary practice location

801 Massachusetts Ave
Crosstown 2
Boston, MA 02118-0211

Mailing address

960 Massachusetts Ave
FL 2 Provider Enrollment
Boston, MA 02118-2560

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220805002596 MA Practitioner - Internal Medicine 4981938784 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Connecticut School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Evans Medical Foundation IncGroup PAC ID 7416946546, 525 clinicians

Practice addresses (Care Compare)

1 Boston Medical Ctr PL
Boston, MA 02118-2908
Phone (617) 638-8000

72 E Newton St
CR Evans 124
Boston, MA 02118-2308
Phone (617) 638-7253

88 E Newton St
Boston, MA 02118-2308
Phone (617) 414-5405

Hospital & facility affiliations

  • Boston Medical Center Hospital, Boston, MA, CCN 220031

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
292362MAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Evans Medical Foundation, Inc. Internal Medicine CurrentSince Sep 1, 2022 Accepting new patients
Boston Medical Center Corporation Current Accepting new patients

Locations

960 Massachusetts Ave
Ste 2
Boston, MA 02118

88 Newton St
Boston, MA 02118
Phone (617) 638-7350

801 Massachusetts Ave
#2
Roxbury, MA 02118
Phone (617) 414-4376

Interoperability endpoints

  • Direct secure messaging: aglick175242@direct.bmc.masshiway.net

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1552694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1609335900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVE",
            "address_2": "FL 2 PROVIDER ENROLLMENT",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 MASSACHUSETTS AVE",
            "address_2": "CROSSTOWN 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021180211",
            "telephone_number": "617-414-7399",
            "fax_number": "617-414-4676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLICK",
        "first_name": "ANDREW",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-16",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "292362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.