NPIMap

Individual provider Active NPI

Mark J Ellenbogen, M.D.

  • Pulmonary Disease Physician
  • Chestnut Hill, MA
National Provider Identifier
1902831001
Registry record updated Jan 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
36631 Issued in MA
Practice address
850 Boylston St
Chestnut Hill, MA 02467
Phone
(617) 732-9900
NPI assigned
Jul 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 36631 MA Primary

Addresses

Primary practice location

850 Boylston St
Chestnut Hill, MA 02467

Mailing address

850 Boylston St
Chestnut Hill, MA 02467-2477

Other practice location 1

1101 Beacon St
Brookline, MA 02446-5587
Phone (617) 731-6333

Other practice location 2

1101 Beacon St
Brookline, MA 02446-5587
Phone (617) 731-6333

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
I20050916000285 MA Practitioner - Pulmonary DiseasePractitioner - Internal Medicine 9436182706 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Internal Medicine
Education
Albert Einstein College of Medicine of Yeshiva University, 1970
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medical Care of Boston Management CorporationGroup PAC ID 6800787714, 293 clinicians

Practice addresses (Care Compare)

93 Pond St
Sharon, MA 02067-2015
Phone (781) 784-9212

Hospital & facility affiliations

  • Mass General Brigham Home Care, Inc Home health agency, Newton, MA, CCN 227207
  • Hebrew Seniorlife - Home Health Care Home health agency, Dedham, MA, CCN 227422
  • Elara Caring Home health agency, Braintree, MA, CCN 227475
  • Beth Israel Deaconess Hospital - Needham Hospital, Needham, MA, CCN 220083
  • Beth Israel Deaconess Medical Center Hospital, Boston, MA, CCN 220086
  • Mount Auburn Hospital Hospital, Cambridge, MA, CCN 220002
  • Brigham and Women'S Hospital Hospital, Boston, MA, CCN 220110
  • Massachusetts General Hospital Hospital, Boston, MA, CCN 220071
  • Encompass Health Braintree Hospital of Braintree Inpatient rehabilitation facility, Braintree, MA, CCN 223027

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Care of Boston Management Corporation CurrentSince Oct 20, 2024 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients

Locations

1101 Beacon St
Brookline, MA 02446
Phone (617) 232-6633

93 Pond St
Sharon, MA 02067
Phone (781) 784-9212

112 Worcester St
Ste 301
Wellesley, MA 02481
Phone (617) 865-0060

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.

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": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547078400000",
    "number": "1902831001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 BOYLSTON ST",
            "city": "CHESTNUT HILL",
            "state": "MA",
            "postal_code": "024672477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 BOYLSTON ST",
            "city": "CHESTNUT HILL",
            "state": "MA",
            "postal_code": "02467",
            "telephone_number": "617-732-9900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 Beacon St",
            "address_purpose": "LOCATION",
            "city": "Brookline",
            "state": "MA",
            "postal_code": "024465587",
            "country_code": "US",
            "telephone_number": "617-731-6333",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1101 Beacon St",
            "address_purpose": "LOCATION",
            "city": "Brookline",
            "state": "MA",
            "postal_code": "024465587",
            "country_code": "US",
            "telephone_number": "617-731-6333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLENBOGEN",
        "first_name": "MARK",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2019-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MA",
            "license": "36631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chestnut Hill, MA

Sources for this page

Verify at the official NPI Registry.