Individual provider Active NPI

Mihoko Tanabe

  • Family Medicine Physician
  • Boston, MA
National Provider Identifier
1720615313
Registry record updated Jul 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1013793 Issued in MA
Practice address
11 Melnea Cass Blvd
Boston, MA 02119-4401
Phone
(617) 414-2080
NPI assigned
Mar 24, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1013793 MA Primary

Addresses

Primary practice location

11 Melnea Cass Blvd
Boston, MA 02119-4401

Mailing address

960 Massachusetts Ave
FL 2
Boston, MA 02118

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
I20230801000411 MA Practitioner - Family Practice 2668883372 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boston University Family Medicine IncGroup PAC ID 0446154074, 67 clinicians

Practice addresses (Care Compare)

1 Boston Medical Ctr PL
Boston, MA 02118-2908
Phone (617) 414-2080

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1013793MAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boston University Family Medicine, Inc. Family Medicine CurrentSince Sep 1, 2023 Accepting new patients
Boston Medical Center Corporation Current Accepting new patients
Boston University Obstetrics and Gynecology Foundation, Inc. PastSince Jul 23, 2023 Accepting new patients

Locations

960 Massachusetts Ave
Ste 2
Boston, MA 02118

1 Boston Medical Ctr Pl
Roxbury, MA 02118
Phone (617) 414-5245

11 Melnea Cass Blvd
Roxbury, MA 02119
Phone (617) 414-6979

Interoperability endpoints

  • Direct secure messaging: mtanabe131385@direct.bmc.masshiway.net
  • Direct secure messaging: mtanabe312009@direct.ochin.org

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 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": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1720615313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVE",
            "address_2": "FL 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 MELNEA CASS BLVD",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021194401",
            "telephone_number": "617-414-2080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANABE",
        "first_name": "MIHOKO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-24",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "1013793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.