NPIMap

Individual provider Active NPI

Johann Nikolas Patlak

  • Anesthesiology Physician
  • Boston, MA
National Provider Identifier
1871868075
Registry record updated Feb 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD16257 Issued in RI
Practice address
330 Brookline Ave
Boston, MA 02215-5400
Phone
(617) 667-3112
NPI assigned
Mar 20, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 20, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 269792 MA
Critical Care Medicine (Anesthesiology) Physician 207LC0200X 269792 MA
Critical Care Medicine (Anesthesiology) Physician 207LC0200X MD16257 RI
Anesthesiology Physician 207L00000X MD16257 RI Primary

Addresses

Primary practice location

330 Brookline Ave
Boston, MA 02215-5400

Mailing address

330 Brookline Ave
Boston, MA 02215-5400
Phone (617) 667-3364

Other practice location 1

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-5172

Other practice location 2

101 Dudley Street
Anesthesiology Dept
Providence, RI 02905-0290
Phone (401) 453-7950

Other identifiers 1

IdentifierTypeStateIssuer
110121258AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20180912002545 RI Practitioner - Anesthesiology 1052697000 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Vermont College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Affinity Physicians LLC.Group PAC ID 0244413391, 723 clinicians
The Miriam HospitalGroup PAC ID 6901796408, 178 clinicians
Lifespan Physician Group IncGroup PAC ID 2567455082, shared by 4 NPIs, 1,151 clinicians

Practice addresses (Care Compare)

101 Dudley St
Providence, RI 02905-2401
Phone (401) 274-1122

164 Summit Ave
Providence, RI 02906-2853
Phone (401) 793-2104

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-6966

593 Eddy St Apc
Suite 6
Providence, RI 02903-4923
Phone (401) 793-9172

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. CurrentSince Aug 1, 2018 Accepting new patients
The Miriam Hospital CurrentSince Jan 17, 2021 Accepting new patients
Lifespan Physician Group, Inc. Anesthesiology CurrentSince Aug 1, 2018 Accepting new patients
Affinity Physicians LLC. Anesthesiology Current Accepting new patients
The Miriam Hospital Critical Care Medicine CurrentSince Jan 17, 2021 Accepting new patients
Lifespan Physician Group, Inc. Critical Care Medicine CurrentSince Dec 1, 2018 Accepting new patients

Locations

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

164 Summit Ave
Providence, RI 02906
Phone (401) 793-2104

593 Eddy St
#6
Providence, RI 02903
Phone (401) 793-9166

593 Eddy St
Providence, RI 02903

101 Dudley St
Providence, RI 02905
Phone (401) 453-7950

455 Toll Gate Rd
Warwick, RI 02886
Phone (401) 737-7000

Organizations & group practices 6

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 8

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": "1332201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1871868075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 BROOKLINE AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022155400",
            "telephone_number": "617-667-3364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 BROOKLINE AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022155400",
            "telephone_number": "617-667-3112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "593 Eddy St",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029034923",
            "country_code": "US",
            "telephone_number": "401-444-5172",
            "fax_number": "401-444-5090",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 Dudley Street",
            "address_2": "Anesthesiology Dept",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029050290",
            "country_code": "US",
            "telephone_number": "401-453-7950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATLAK",
        "first_name": "JOHANN",
        "middle_name": "NIKOLAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-20",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MA",
            "license": "269792",
            "primary": false
        },
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "MA",
            "license": "269792",
            "primary": false
        },
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "RI",
            "license": "MD16257",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "RI",
            "license": "MD16257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110121258A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.