Individual provider Active NPI

Masanori Takeoka, MD

  • Neurology with Special Qualifications in Child Neurology Physician
  • Boston, MA
National Provider Identifier
1780602227
Registry record updated Aug 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
203444 Issued in MA
Practice address
300 Longwood Ave
Fegan 9
Boston, MA 02115-5724
Phone
(617) 355-7970
Fax
(617) 730-0463
NPI assigned
Jul 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 203444 MA Primary
Clinical Neurophysiology Physician 2084N0600X 203444 MA

Addresses

Primary practice location

300 Longwood Ave
Fegan 9
Boston, MA 02115-5724

Mailing address

300 Longwood Ave
Fegan 9
Boston, MA 02115-5724
Phone (617) 355-7970

Other identifiers 1

IdentifierTypeStateIssuer
2029812MedicaidMA

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
I20040412000957 MA Practitioner - Neurology 4385638527 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
C H Neurology Foundation IncGroup PAC ID 5496744195, 56 clinicians

Practice addresses (Care Compare)

300 Longwood Ave
Boston, MA 02115-5724
Phone (617) 355-6000

Hospital & facility affiliations

  • Boston Children'S Hospital Hospital, Boston, MA, CCN 223302

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
C H Neurology Foundation Inc Neurology With Special Qualifications in Child Neurology CurrentSince Jan 13, 2004 Accepting new patients
Childrens Hospital Boston Past Accepting new patients
Pratt Pediatric Associates Inc Neurology With Special Qualifications in Child Neurology Past Accepting new patients

Locations

300 Longwood Ave
Boston, MA 02115
Phone (617) 355-4956

300 Longwood Ave
#9
Boston, MA 02115
Phone (617) 355-2413

Interoperability endpoints

  • Direct secure messaging: mtakeoka66110@direct.bostonchildrens.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 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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187913600000",
    "number": "1780602227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "address_2": "FEGAN 9",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155724",
            "telephone_number": "617-355-7970",
            "fax_number": "617-730-0463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "address_2": "FEGAN 9",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155724",
            "telephone_number": "617-355-7970",
            "fax_number": "617-730-0463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKEOKA",
        "first_name": "MASANORI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "MA",
            "license": "203444",
            "primary": true
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "MA",
            "license": "203444",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2029812",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.