Roosevelt Lewis III, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN2313246 Issued in MA

Practice address

1208 VFW Pkwy Ste 301
Boston, MA 02132-4344

Phone

(617) 401-7441

Fax

(617) 203-6651

NPI assigned

Sep 5, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 16, 2022 through Apr 16, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Unitas Healthcare Systems, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Boston, MA
  • NPI 1073096624

  Psychiatric/Mental Health

  NPD Authorized official
• Sacred Psychiatry, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portland, OR
  • NPI 1952996076

  Psychiatric/Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1504569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1649798133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 VFW PKWY STE 301",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021324344",
            "telephone_number": "617-401-7441",
            "fax_number": "617-203-6651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208 VFW PKWY STE 301",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021324344",
            "telephone_number": "617-401-7441",
            "fax_number": "617-203-6651"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1208 Vfw Pkwy Ste 301",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021324344",
            "country_code": "US",
            "telephone_number": "617-401-7441 x101",
            "fax_number": "617-203-6651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "ROOSEVELT",
        "name_suffix": "III",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-09-05",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MA",
            "license": "RN2313246",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2313246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Andrew Lewis, M.D.
• Nicole Rose Lewis, M.S.P.A.S- P.A.-C.
• Noah Daniel Hurst Lewis, MD
• Rebecca Michelle Lewis, AU.D., PH.D.
• Richard F. Lewis, M.D.
• Shayna Nicole Lewis
• Skyla Rae Lewis, PA-C
• Stanley M Lewis, M.D.
• Susan Ann Lewis, PA-C
• Tayanna Lewis

• Psychiatric/Mental Health Nurse Practitioner in Boston, MA
• Providers in Boston, MA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.