NPIMap

Individual provider Active NPI

Alyson Mackenzie Bracken, P.A.

  • Medical Physician Assistant
  • West Roxbury, MA
National Provider Identifier
1861642274
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
AP2611 Issued in MA
Practice address
1832 Centre St
West Roxbury, MA 02132-1901
Phone
(617) 469-4000
NPI assigned
Sep 22, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X AP2611 MA Primary

Addresses

Primary practice location

1832 Centre St
West Roxbury, MA 02132-1901

Mailing address

1832 Centre St
West Roxbury, MA 02132-1901
Phone (617) 469-4000

Other practice location 1

780 Albany St
Boston, MA 02118-2755
Phone (857) 654-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081204000508 MA Practitioner - Physician Assistant 4688735947 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1832 Centre St
West Roxbury, MA 02132-1901
Phone (617) 469-4000

75 Francis St
Boston, MA 02115-6110
Phone (617) 732-5500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2611MAMDBehavioral Analyst
AP2611MAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Health Care for the Homeless Program, Inc. CurrentSince Mar 13, 2024 Accepting new patients
Boston Health Care for the Homeless Program, Inc. CurrentSince Mar 13, 2024 Accepting new patients
Brigham and Women's Faulkner Hospital, Inc Current Accepting new patients

Locations

780 Albany St
#2130
Boston, MA 02118

780 Albany St
Boston, MA 02118
Phone (857) 654-1000

75 Francis St
Boston, MA 02115

Interoperability endpoints

  • Direct secure messaging: bracken.alyson.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 4

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": "1222041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1861642274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1832 CENTRE ST",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021321901",
            "telephone_number": "617-469-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1832 CENTRE ST",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021321901",
            "telephone_number": "617-469-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "780 Albany St",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021182755",
            "country_code": "US",
            "telephone_number": "857-654-1000",
            "fax_number": "857-654-1100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRACKEN",
        "first_name": "ALYSON",
        "middle_name": "MACKENZIE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-22",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "AP2611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Roxbury, MA

Sources for this page

Verify at the official NPI Registry.