Individual provider Active NPI

William J Brucker III, M.D.

  • Clinical Genetics (M.D.) Physician
  • Boston, MA
National Provider Identifier
1942543962
Registry record updated Oct 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Genetics (M.D.) PhysicianTaxonomy code 207SG0201X
License
269038 Issued in MA
Practice address
300 Longwood Ave
Boston, MA 02115-5724
Phone
(617) 355-6000
NPI assigned
Mar 27, 2013
Last updated
Oct 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Genetics (M.D.) Physician 207SG0201X 269038 MA Primary

Addresses

Primary practice location

300 Longwood Ave
Boston, MA 02115-5724

Mailing address

300 Longwood Ave
Boston, MA 02115-5724
Phone (617) 355-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, MA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200916000865 RI Practitioner - Pediatric Medicine 3072816511 Reassigns benefits to 2 organizations
I20241025000820 MA Practitioner - Medical Genetics and Genomics 3072816511 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Medical Genetics and Genomics
Education
Warren Alpert Medical School of Brown University, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Children's Hospital Pediatric Associates, IncGroup PAC ID 3476541830, 333 clinicians

Practice addresses (Care Compare)

300 Longwood Ave
Boston, MA 02115-5724
Phone (617) 355-6000

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Affinity Physicians LLC CurrentSince Oct 1, 2020 Accepting new patients
Affinity Physicians LLC. Pediatrics CurrentSince Oct 1, 2020 Accepting new patients
Rhode Island Hospital CurrentSince Oct 1, 2020 Accepting new patients
Children's Hospital Pediatric Associates, Inc Pediatrics CurrentSince Sep 20, 2024 Accepting new patients
Rhode Island Hospital Pediatrics CurrentSince Aug 1, 2020 Accepting new patients
Rhode Island Hospital CurrentSince Aug 1, 2020 Accepting new patients

Locations

300 Longwood Ave
Boston, MA 02115
Phone (617) 355-4956

1454 S County Trl
Ste 2100
East Greenwich, RI 02818
Phone (401) 606-2000

407 East Ave
Ste 200
Pawtucket, RI 02860
Phone (401) 312-0023

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

593 Eddy St
#138
Providence, RI 02903
Phone (401) 444-5291

593 Eddy St
Ste 5
Providence, RI 02903
Phone (401) 444-3996

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

Interoperability endpoints

  • Direct secure messaging: bbrucker250044@direct.bostonchildrens.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1364342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1942543962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155724",
            "telephone_number": "617-355-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155724",
            "telephone_number": "617-355-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCKER",
        "first_name": "WILLIAM",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-03-27",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207SG0201X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": "MA",
            "license": "269038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.