DR. IVY LYNN BRACKUP (MD) – Contractor, NPI 1184691891
Contractor
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,899 FAMILY PRACTICE in MA
Provider Addresses for DR. IVY LYNN BRACKUP (MD)
1353 DORCHESTER AVE
DORCHESTER, MA 021222932
Phone: (617) 288-3230
Type: Mailing
372, Washington Street, Linden Street, Wellesley Hills, Wellesley, Norfolk County, Massachusetts, 02181, United States
MARINO CENTER FOR INTEGRATIVE HEALTH
WELLESLEY, MA 02481
Phone: (781) 235-5200
Fax: (617) 382-1101
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2009-12-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20091207000688 | I | Family Practice | MA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 79 | 32 | $0 |
Insurance plans in this area (ZIP 02122)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | DC | |
| - | MA | |
| Certified Clinical Nurse Specialist (Cns) | MA | |
| O P T O M E T R Y | NH | |
| Nurse Practitioner | MA | |
| P S Y C H I A T R Y | MA | |
| Certified Clinical Nurse Specialist (Cns) | MA | |
| Certified Nurse Midwife (Cnm) | MA | |
| Certified Nurse Midwife (Cnm) | MA | |
| D E R M A T O L O G Y | MA |
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