Active NPI
Eugene Adivoso Bacorro, M.D.
- Rheumatology Physician
- West Roxbury, MA
National Provider Identifier
1659530137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- 245971
- Practice address
- 1400 VFW Pkwy
West Roxbury, MA 02132-4927 - Phone
- (617) 323-7700
- NPI assigned
- Jun 9, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | 245971 | MA | Primary |
Addresses
Primary practice location
1400 VFW Pkwy
West Roxbury, MA 02132-4927
Mailing address
10 Payson St
Lexington, MA 02421-7924
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 245971 | MA | MD | Rheumatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684972800000",
"number": "1659530137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 PAYSON ST",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "024217924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 VFW PKWY",
"city": "WEST ROXBURY",
"state": "MA",
"postal_code": "021324927",
"telephone_number": "617-323-7700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACORRO",
"first_name": "EUGENE",
"middle_name": "ADIVOSO",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-09",
"last_updated": "2023-05-25",
"certification_date": "2023-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "MA",
"license": "245971",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Roxbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.