NPIMap

Organization Active NPI

Evans Medical Foundation, Inc.

Doing business as Boston University Internal Medicine Associates

  • Internal Medicine Physician
  • Boston, MA
National Provider Identifier
1912954124
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
EVANS MEDICAL FOUNDATION, INC.
Doing business as
Boston University Internal Medicine Associates
Practice address
1 Boston Medical Ctr PL
Boston, MA 02118-2908
Phone
(617) 358-3510
NPI assigned
May 31, 2006
Last updated
Jun 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

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

Authorized official

Name
Dr. Sushrut S. Waikar, MDNPI 1801879150
Title
Interim President
Phone
(617) 414-8680

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X NU
Internal Medicine Physician 207R00000X NU Primary
Cardiovascular Disease Physician 207RC0000X NU
Endocrinology, Diabetes & Metabolism Physician 207RE0101X NU
Gastroenterology Physician 207RG0100X NU
Geriatric Medicine (Internal Medicine) Physician 207RG0300X NU
Hematology & Oncology Physician 207RH0003X NU
Infectious Disease Physician 207RI0200X NU
Nephrology Physician 207RN0300X NU
Pulmonary Disease Physician 207RP1001X NU
Rheumatology Physician 207RR0500X NU

Addresses

Primary practice location

1 Boston Medical Ctr PL
Boston, MA 02118-2908

Mailing address

960 Massachusetts Ave
FL 2
Boston, MA 02118-2690

Other identifiers 2

IdentifierTypeStateIssuer
3089030MedicaidNH
110056578EMedicaidMA

Other names 2

  • Boston University Internal Medicine Associates Doing business as
  • Faculty Practice Foundation Inc Evans Medical Foundation Inc Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040512000397 MA Part B Supplier - Clinic/Group Practice 7416946546 Receives reassigned benefits from 581 practitioners
Practice locations: Dorchester, MA; Hyde Park, MA; Jamaica Plain, MA; Mattapan, MA; Medford, MA; North Quincy, MA; Roxbury, MA; South Boston, MA…

National Provider Directory

National Provider Directory
Tax ID family
Evans Medical Foundation Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

725 Albany St
#5
Boston, MA 02118
Phone (617) 414-5941

725 Albany St
#9B
Boston, MA 02118
Phone (617) 414-4290

725 Albany St
Bldg 7B
Boston, MA 02118

725 Albany St
Bldg 8A
Boston, MA 02118

725 Albany St
Fl 6
Boston, MA 02118
Phone (617) 414-2243

725 Albany St
Ste A
Boston, MA 02118
Phone (617) 414-4861

725 Albany St
Ste Bc
Boston, MA 02118

732 Harrison Ave
#3
Boston, MA 02118
Phone (617) 534-4967

732 Harrison Ave
Fl 2
Boston, MA 02118
Phone (617) 414-0040

801 Massachusetts Ave
Bldg Gim
Boston, MA 02118

801 Massachusetts Ave
Fl 2
Boston, MA 02118
Phone (617) 414-4376

88 East Newton St
#124
Boston, MA 02118
Phone (617) 638-5600

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 788

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 788

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1912954124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVE",
            "address_2": "FL 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BOSTON MEDICAL CTR PL",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182908",
            "telephone_number": "617-358-3510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANS MEDICAL FOUNDATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "WAIKAR",
        "authorized_official_first_name": "SUSHRUT",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "INTERIM PRESIDENT",
        "authorized_official_telephone_number": "617-414-8680",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3089030",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110056578E",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boston University Internal Medicine Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Faculty Practice Foundation Inc Evans Medical Foundation Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Faculty Practice Foundation Inc Evans Medical Foundation Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.