Active NPI
Kimberly Bistis, PSYD
- Psychologist
- Boston, MA
National Provider Identifier
1831180280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 7480
- Practice address
- 294 Washington St.
Suite 415
Boston, MA 02108-4639 - Phone
- (617) 571-6688
- NPI assigned
- Nov 3, 2005
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 7480 | MA | Primary |
Addresses
Primary practice location
294 Washington St.
Suite 415
Boston, MA 02108-4639
Mailing address
328 Copeland St..
3F
Quincy, MA 02169-4030
Phone (617) 571-6688
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1859986 | Medicaid | MA | |
| W05968 | Other | MA | BCBS MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7480 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434931200000",
"number": "1831180280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "328 COPELAND ST..",
"address_2": "3F",
"city": "QUINCY",
"state": "MA",
"postal_code": "021694030",
"telephone_number": "617-571-6688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "294 WASHINGTON ST.",
"address_2": "SUITE 415",
"city": "BOSTON",
"state": "MA",
"postal_code": "021084639",
"telephone_number": "617-571-6688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BISTIS",
"first_name": "KIMBERLY",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-11-03",
"last_updated": "2015-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "7480",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1859986",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MA",
"identifier": "W05968",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.