NPIMap

Individual provider Active NPI

Amitabh Srivastava, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Boston, MA
National Provider Identifier
1649260100
Registry record updated Dec 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
219855 Issued in MA
Practice address
75 Francis Street, Amory 3
Boston, MA 02115
Phone
(617) 732-7510
Fax
(617) 264-5118
NPI assigned
Oct 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 219855 MA Primary

Addresses

Primary practice location

75 Francis Street, Amory 3
Boston, MA 02115

Mailing address

75 Francis Street, Amory 3
Boston, MA 02115
Phone (617) 732-7510

Other identifiers 3

IdentifierTypeStateIssuer
468390OtherMATUFTS HEALTH PLAN
J28666OtherMABCBS MA
2101866MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050808000791 MA Practitioner - Pathology 8426087685 Reassigns benefits to 1 organization
I20220420000850 NY Practitioner - Pathology 8426087685 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Pathology GroupGroup PAC ID 0749179158, 98 clinicians

Practice addresses (Care Compare)

1275 York Ave
New York, NY 10065-6007
Phone (212) 639-2000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Pathology Group Anatomic Pathology & Clinical Pathology CurrentSince Mar 1, 2022 Accepting new patients

Locations

1275 York Ave
New York, NY 10065
Phone (212) 639-3813

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989

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 11

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": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1649260100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 FRANCIS STREET, AMORY 3",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02115",
            "telephone_number": "617-732-7510",
            "fax_number": "617-264-5118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 FRANCIS STREET, AMORY 3",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02115",
            "telephone_number": "617-732-7510",
            "fax_number": "617-264-5118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SRIVASTAVA",
        "first_name": "AMITABH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MA",
            "license": "219855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "468390",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MA",
            "identifier": "J28666",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2101866",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.