Unknown Individual – Psychiatry Physician, NPI 1114063880
Psychiatry Physician
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Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
PO Box 846028, Albany Street, Church Green, Financial District, Boston, Suffolk County, Massachusetts, 02284-6028, United States
BOSTON, MA 022415348
Phone: (800) 882-2225
Fax: (508) 334-1977
Type: Mailing
UMASS Memorial Medical Center University Campus Hospital, 55, Lake Avenue North, Worcester, Worcester County, Massachusetts, 01653, United States
WORCESTER, MA 016550002
Phone: (774) 443-2761
Fax: (774) 442-1899
Type: Location
221 Longwood Ave
BWH Department of Psychiatry
Boston, MA 021155804
Phone: (617) 732-6753
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $21.
Total Amount is formed as General ($21) + Research ($0) + Ownership ($0) = $21.
Last reported payment date: 2024-09-18 • Largest payer in this snapshot: ACADIA Pharmaceuticals Inc ($21).
Total Amount
$21
General + Research + Ownership
Payments
1
Total payment records
General Amount
$21
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-18
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ACADIA Pharmaceuticals Inc | $21 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 02241)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PSYCHIATRY | MA | 90792 | Psychiatric diagnostic evaluation with medical services | 26 | 26 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Certified Registered Nurse Anesthetist (Crna) | MA | |
| - | MA | |
| - | MA | |
| Family Practice | MA | |
| Physician Assistant | MA | |
| Pulmonary Disease, Critical Care (Intensivists), Allergy/Immunology | MA | |
| - | MA | |
| - | MA | |
| Internal Medicine | MA | |
| Nurse Practitioner | MA |
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