Individual provider Active NPI

Teana Krystal Gravel Mariere, DO

  • Emergency Medicine Physician
  • Brockton, MA
National Provider Identifier
1669048831
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
1018780 Issued in MA
Practice address
680 Centre St
Brockton, MA 02302-3308
Phone
(508) 941-7000
NPI assigned
May 28, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 1018780 MA Primary

Addresses

Primary practice location

680 Centre St
Brockton, MA 02302-3308

Mailing address

680 Centre St
Brockton, MA 02302-3308
Phone (508) 941-7000

Other names 1

  • Teana Krystal Gravel Former name

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
I20240723002281 MA Practitioner - Emergency Medicine 7214339597 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brockton Hospital, Inc.Group PAC ID 4082504733, 36 clinicians

Practice addresses (Care Compare)

680 Centre St
Brockton, MA 02302-3308
Phone (508) 941-7000

Hospital & facility affiliations

  • Signature Healthcare Brockton Hospital Hospital, Brockton, MA, CCN 220052

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1018780MAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Brockton Hospital, Inc. CurrentSince Aug 1, 2024 Accepting new patients
Signature Healthcare Medical Group Inc Current Accepting new patients
Brockton Hospital, Inc. CurrentSince Aug 1, 2024 Accepting new patients

Locations

680 Centre St
Brockton, MA 02302
Phone (508) 941-7400

Interoperability endpoints

  • Direct secure messaging: teana.gravel.mariere@direct.signature.masshiway.net

Organizations & group practices 3

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 1

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": "1622160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1669048831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 CENTRE ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023023308",
            "telephone_number": "508-941-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 CENTRE ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023023308",
            "telephone_number": "508-941-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVEL MARIERE",
        "first_name": "TEANA",
        "middle_name": "KRYSTAL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-28",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MA",
            "license": "1018780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TEANA",
            "last_name": "GRAVEL",
            "middle_name": "KRYSTAL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.