NPIMap

Organization Active NPI

North Shore Nurse Practitioner Associates, LLC

  • Psychiatry Physician
  • Danvers, MA
National Provider Identifier
1932362613
Registry record updated Dec 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
201757 Issued in MA
Legal business name
NORTH SHORE NURSE PRACTITIONER ASSOCIATES, LLC
Practice address
85 Constitution LN
Suite 300a
Danvers, MA 01923-3694
Phone
(978) 750-0755
Fax
(978) 750-0766
NPI assigned
Jul 3, 2008
Last updated
Dec 30, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2015

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

Authorized official

Name
Christine Dale Raucci, APRNNPI 1598711780
Title
Owner / Partner
Phone
(978) 750-0755

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 125049 MA
Psychiatry Physician 2084P0800X 201757 MA Primary

Addresses

Primary practice location

85 Constitution LN
Suite 300a
Danvers, MA 01923-3694

Mailing address

85 Constitution LN
Suite 300a
Danvers, MA 01923-3694
Phone (978) 750-0755

Other identifiers 1

IdentifierTypeStateIssuer
1893327MedicaidMA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090216000355 MA Part B Supplier - Clinic/Group Practice 5395800924 Receives reassigned benefits from 3 practitioners
Practice locations: Danvers, MA

National Provider Directory

National Provider Directory

Locations

435 Newbury St
Ste 209
Danvers, MA 01923
Phone (978) 750-0755

85 Constitution Ln
#300A
Danvers, MA 01923
Phone (978) 626-1105

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451433600000",
    "number": "1932362613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 CONSTITUTION LN",
            "address_2": "SUITE 300A",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019233694",
            "telephone_number": "978-750-0755",
            "fax_number": "978-750-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 CONSTITUTION LN",
            "address_2": "SUITE 300A",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019233694",
            "telephone_number": "978-750-0755",
            "fax_number": "978-750-0766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE NURSE PRACTITIONER ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-03",
        "last_updated": "2015-12-30",
        "status": "A",
        "authorized_official_last_name": "RAUCCI",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "OWNER / PARTNER",
        "authorized_official_telephone_number": "978-750-0755",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "125049",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "201757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1893327",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danvers, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2015; 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.