Active NPI
Rey Arlen Vanderpool
- Registered Dietitian
- Cambridge, MA
National Provider Identifier
1750893004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 4405
- Practice address
- 158 Mount Auburn St Ste 1
Cambridge, MA 02138-4876 - Phone
- (339) 545-1036
- Fax
- (617) 716-5571
- NPI assigned
- Oct 26, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 4405 | MA | Primary |
Addresses
Primary practice location
158 Mount Auburn St Ste 1
Cambridge, MA 02138-4876
Mailing address
158 Mount Auburn St Ste 1
Cambridge, MA 02138-4876
Phone (339) 545-1036
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190604000985 | MA | Practitioner - Registered Dietitian Or Nutrition Professional | 0941533103 | Practice locations: Cambridge, MA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4405 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664755200000",
"number": "1750893004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "158 MOUNT AUBURN ST STE 1",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021384876",
"telephone_number": "339-545-1036",
"fax_number": "617-716-5571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "158 MOUNT AUBURN ST STE 1",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021384876",
"telephone_number": "339-545-1036",
"fax_number": "617-716-5571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERPOOL",
"first_name": "REY",
"middle_name": "ARLEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-26",
"last_updated": "2022-10-03",
"certification_date": "2022-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MA",
"license": "4405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.