Active NPI
Kimberley Shui-Yan Mak, M.D., M.P.H.
- Radiation Oncology Physician
- Boston, MA
National Provider Identifier
1891015350
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiation Oncology Physician
- License
- 253487
- Practice address
- 830 Harrison Ave
Moakley Ll100
Boston, MA 02118-2905 - Phone
- (617) 638-7070
- Fax
- (617) 638-7037
- NPI assigned
- Jun 8, 2010
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | 253487 | MA | Primary |
Addresses
Primary practice location
830 Harrison Ave
Moakley Ll100
Boston, MA 02118-2905
Mailing address
801 Albany Street
FL G
Boston, MA 02119-3791
Phone (617) 414-5405
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110103293A | Medicaid | MA |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Radiation Oncology
- Education
- Harvard Medical School, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
830 Harrison Ave
Ll100
Boston, MA 02118-2905
Phone (617) 638-7070
Hospital & facility affiliations
- Boston Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 253487 | MA | MD | Radiation Oncology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| BMC Affiliated Physicians, Inc. | Current | Accepting new patients | |
| Boston University Radiation Oncology, Inc. | Radiation Oncology | Current | Accepting new patients |
Locations
235 N Pearl St
Brockton, MA 02301
Phone (508) 427-2525
801 Albany St
Fl G
Roxbury, MA 02119
720 Harrison Ave
#503
Roxbury, MA 02118
Phone 6174145404 ext. 2
Interoperability endpoints
- kmak73344@direct.bmc.masshiway.net
Organizations & group practices 2
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.
-
- Radiation Oncology Physician
- Boston, MA
- NPI 1912362351
-
- Internal Medicine Physician
- Boston, MA
- NPI 1245320910
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Boston, MA
- NPI 1164177028
-
- Community Health Clinic/Center
- South Boston, MA
- NPI 1225228679
Hospital
-
- General Acute Care Hospital
- Boston, MA
- NPI 1346218294
-
- Community Health Clinic/Center
- Roslindale, MA
- NPI 1386718823
Hospital
-
- Community Health Clinic/Center
- Dorchester, MA
- NPI 1780874677
Hospital
-
- Community Health Clinic/Center
- East Boston, MA
- NPI 1861683518
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613520000000",
"number": "1891015350",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 ALBANY STREET",
"address_2": "FL G",
"city": "BOSTON",
"state": "MA",
"postal_code": "021193791",
"telephone_number": "617-414-5405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "830 HARRISON AVE",
"address_2": "MOAKLEY LL100",
"city": "BOSTON",
"state": "MA",
"postal_code": "021182905",
"telephone_number": "617-638-7070",
"fax_number": "617-638-7037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAK",
"first_name": "KIMBERLEY",
"middle_name": "SHUI-YAN",
"credential": "M.D., M.P.H.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-08",
"last_updated": "2021-02-17",
"certification_date": "2021-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "",
"desc": "Radiology, Radiation Oncology",
"state": "MA",
"license": "253487",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110103293A",
"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 Feb 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.