Individual provider Active NPI

Samantha Donovan, PA-C

  • Physician Assistant
  • Boston, MA
National Provider Identifier
1962917690
Registry record updated Dec 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA6237 Issued in MA
Practice address
75 Francis Street
Cardiovascular Medicine: PBB-1
Boston, MA 02115
Phone
(617) 732-8732
NPI assigned
Dec 4, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA6237 MA Primary

Addresses

Primary practice location

75 Francis Street
Cardiovascular Medicine: PBB-1
Boston, MA 02115

Mailing address

130 Bowdoin St Apt 506
Boston, MA 02108-2722
Phone (781) 201-9300

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180205002580 MA Practitioner - Physician Assistant 7416217773 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

450 Brookline Ave
Boston, MA 02215-5418
Phone (617) 632-3000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA6237MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Brigham and Women'S Hospital Current Accepting new patients
Dana-Farber Cancer Institute, Inc. CurrentSince Dec 1, 2019 Accepting new patients
Dana-Farber Cancer Institute, Inc. CurrentSince Dec 1, 2019 Accepting new patients
Brigham and Womens Physicians Organization Inc Past Accepting new patients

Locations

75 Francis St
#1
Boston, MA 02115
Phone (617) 732-6310

450 Brookline Ave
Boston, MA 02215
Phone (508) 478-2061

75 Francis St
Boston, MA 02115

Interoperability endpoints

  • Direct secure messaging: donovan.samantha.bwh@direct.partners.masshiway.net

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1512345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512345600000",
    "number": "1962917690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 BOWDOIN ST APT 506",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021082722",
            "telephone_number": "781-201-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 FRANCIS STREET",
            "address_2": "CARDIOVASCULAR MEDICINE: PBB-1",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02115",
            "telephone_number": "617-732-8732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONOVAN",
        "first_name": "SAMANTHA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-04",
        "last_updated": "2017-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA6237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.