Elias Mbogo, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LN94430 Issued in MA

Practice address

200 Springs Rd
Bedford, MA 01730-1114

Phone

(781) 687-3872

NPI assigned

Oct 19, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: elias.mbogo@va.gov

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

{
    "created_epoch": "1603065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603065600000",
    "number": "1740889161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 B ST",
            "city": "DRACUT",
            "state": "MA",
            "postal_code": "018262153",
            "telephone_number": "781-228-1513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SPRINGS RD",
            "city": "BEDFORD",
            "state": "MA",
            "postal_code": "017301114",
            "telephone_number": "781-687-3872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MBOGO",
        "first_name": "ELIAS",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-19",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MA",
            "license": "LN94430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSING LICENSE",
            "identifier": "LN94430",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Elias.Mbogo@va.gov",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "200 Springs Rd",
            "city": "Bedford",
            "state": "MA",
            "country_code": "US",
            "postal_code": "017301114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Valerie Yvonne Marte, LMHC
• Jeanne Mary Martin, PHARM.D.
• Alexis Martins
• Kaven Matyczynski
• Adam Mayhew
• Theresa McCarthy
• Susan Plugis McCartney, OTR/L
• Helen V McClarence, RD LDN M ED
• Quinn McClernan
• Hayley Elizabeth McDonald, MS, BCBA, LABA

• Licensed Practical Nurse in Bedford, MA
• Providers in Bedford, MA by specialty
• Licensed Practical Nurse in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.