Individual provider Active NPI

Manisha Thakuria, M.D.

  • Clinical & Laboratory Dermatological Immunology Physician
  • Boston, MA
National Provider Identifier
1760504880
Registry record updated Nov 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical & Laboratory Dermatological Immunology PhysicianTaxonomy code 207NI0002X
License
245821 Issued in MA
Practice address
221 Longwood Ave
Boston, MA 02115-5804
Phone
(617) 732-4918
NPI assigned
Apr 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical & Laboratory Dermatological Immunology Physician 207NI0002X 245821 MA Primary
Student in an Organized Health Care Education/Training Program 390200000X 4301088143 MI

Addresses

Primary practice location

221 Longwood Ave
Boston, MA 02115-5804

Mailing address

375 Boylston St
Brookline, MA 02445-6007
Phone (857) 307-0867

Other identifiers 1

IdentifierTypeStateIssuer
110087251AMedicaidMA

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
I20101228000421 MA Practitioner - Dermatology 3678761152 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

221 Longwood Ave
Boston, MA 02115-5804
Phone (617) 732-5500

450 Brookline Ave
Boston, MA 02215-5418
Phone (617) 632-3586

450 Brookline Ave
Boston, MA 02215-5450

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions360
Removal or shaving of skin growth1-10
Skin biopsy151

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
245821MAMDClinical & Laboratory Dermatological Immunology Physician
4301088143MIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Brigham and Women'S Hospital Current Accepting new patients
Dana-Farber Cancer Institute, Inc. CurrentSince Oct 1, 2011 Accepting new patients
Dana-Farber Cancer Institute, Inc. CurrentSince Oct 1, 2011 Accepting new patients
Brigham and Womens Physicians Organization Inc Past Accepting new patients

Locations

450 Brookline Ave
Boston, MA 02215
Phone (508) 478-2061

221 Longwood Ave
Boston, MA 02115
Phone (617) 732-4918

75 Francis St
Boston, MA 02115

Interoperability endpoints

  • Direct secure messaging: thakuria.manisha.bwh@direct.partners.masshiway.net

Organizations & group practices 5

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 2

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": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574294400000",
    "number": "1760504880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 BOYLSTON ST",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024456007",
            "telephone_number": "857-307-0867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 LONGWOOD AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155804",
            "telephone_number": "617-732-4918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAKURIA",
        "first_name": "MANISHA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-06",
        "last_updated": "2019-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "MA",
            "license": "245821",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4301088143",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110087251A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.