DR. ELISE MARIE HENRICKS (NPI# 1154392850) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154392850 |
| Entity Type | Individual |
| Full Name | DR. ELISE MARIE HENRICKS |
| Credential | MD |
| Practice Address |
415 Columbia Rd Dorchester MA 02125-2424 |
| Practice Telephone | 6177408075 |
| Practice Fax Number | 6177408060 |
| Mailing Telephone | 6177408075 |
| Mailing Fax Number | 6177408060 |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2012-01-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 156706 | MA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| HARVARD PILGRIM | 710514BMC | 01 | |
| MA | 3184846 | 05 | |
| AETNA/USHEALTHCARE | 44447 | 01 | |
| TUFTS | 156706 | 01 | |
| HMO BLUE | J19583 | 01 |
| Street Address |
415 COLUMBIA RD |
| City | DORCHESTER |
| State | MA |
| Zip Code | 02125-2424 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558332270 | Elisabeth Joan Moths-rebrovic | Family Medicine | 415 Columbia Rd, Dorchester, MA 02125-2424 | 2006-01-30 |
| 1386251437 | Laurel Carr Frazier | Case Management | 415 Columbia Rd, Dorchester, MA 02125-2424 | 2020-09-23 |
| 1104441203 | Shamila Ali | Pharmacist | 415 Columbia Rd, Dorchester, MA 02125-2424 | 2020-06-15 |
| 1508486861 | Norma I Gonzalez | Registered Nurse | 415 Columbia Rd, Dorchester, MA 02125-2424 | 2020-04-16 |
| 1790304533 | Bettina Brea | Registered Nurse | 415 Columbia Rd, Dorchester, MA 02125-2424 | 2020-04-12 |
| 1538795935 | Abigail Rose Rezendes | Registered Nurse | 415 Columbia Rd, Dorchester, MA 02125-2424 | 2020-03-17 |
| 1538793997 | Antonette R Kennedy | Registered Nurse | 415 Columbia Rd, Dorchester, MA 02125-2424 | 2020-02-25 |
| 1992338339 | Ashley Felix | Social Worker | 415 Columbia Rd, Dorchester, MA 02125-2424 | 2020-02-13 |
| 1134762396 | Julmide Eugene | Licensed Practical Nurse | 415 Columbia Rd, Dorchester, MA 02125-2424 | 2019-10-21 |
| 1093358368 | Cini Pillai-kadu | Registered Nurse | 415 Columbia Rd, Dorchester, MA 02125-2424 | 2019-10-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922520840 | Aj Guerrero | Counselor | 6 Glen St. #3, Boston, MA 02125 | 2017-07-12 |
| 1982059218 | Ana Fernandez | Psychologist | University of Massachusetts, Boston, 100 William T. Morrissey Blvd, Boston, MA 02125 | 2016-04-23 |
| 1558725184 | Algecira Garcia-ortiz | Massage Therapist | 12 Judson St, Dorchester, MASSACHUSETTS 02125 | 2016-04-10 |
| 1508251414 | Sing Hong Ty | Registered Nurse | 415 Colombia Rd, Dorchester, MA 02125 | 2015-03-30 |
| 1972806750 | Joanne Pomales | Counselor | 18 Harbor Crest Court 102, Dorchester, MA 02125 | 2010-12-16 |
| 1386969335 | Kara Jillian Sheridan | Counselor | 58 Dorset St, Boston, MA 02125 | 2010-04-02 |
| 1750533956 | Wendy M. Jern | Physical Therapist | 21riley Rd #2, Hyde Park, MA 02125 | 2008-10-21 |
| 1174729743 | Payton Brandyberry | Counselor | 500 Columbia Rd, Mail Stop 415-05, Upham's Corner Health Center, Dorchester, MA 02125 | 2007-06-21 |
| 1699817247 | Dong Lan Corporation | Pharmacist | 1167 A Dorchester Ave, Dorchester, MA 02125 | 2007-02-12 |
| 1457490153 | Sarah L Merin | Social Worker | Upham's Corner Health Center, 500 Columbia Rd, Mailstop 415-05, Dorchester, MA 02125 | 2007-02-06 |
| Find all providers in zip 02125 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932580495 | Ankur Patel | Family Medicine | 2100 Dorchester Ave Bldg Suite314, Dorchester, MA 02124-5615 | 2015-06-10 |
| 1730238270 | An Ngoc Thai | Family Medicine | 1443b Dorchester Ave, Dorchester, MA 02122-1347 | 2007-01-10 |
| 1588674030 | An T Phan | Family Medicine | 1370 Dorchester Ave, Ste 23, Dorchester, MA 02122-2921 | 2006-08-08 |
| 1265477145 | Jean Suzin Whitten | Family Medicine | 398 Neponset Avenue, Dorchester, MA 02122 | 2006-06-17 |
| 1255378204 | Grier H Merwin | Family Medicine | 500 Columbia Road, Upham's Corner Health Ctr, Dorchester, MA 02125 | 2006-05-31 |
| 1558332270 | Elisabeth Joan Moths-rebrovic | Family Medicine | 415 Columbia Rd, Dorchester, MA 02125-2424 | 2006-01-30 |
| 1871579342 | Stephenson Bernard Tobierre | Family Medicine | 637 Washington Street, Dorchester, MA 02124 | 2005-12-16 |
| 1992791883 | Christine Farrell-riley | Family Medicine | 637 Washington St, Dorchester, MA 02124-3510 | 2005-09-26 |
| 1023002169 | Geoffrey Alan Modest | Family Medicine | 500 Columbia Rd, Dorchester, MA 02125-2322 | 2005-09-05 |
| 1154321347 | Chinh Van Le | Family Medicine | 2100 Dorchester Avenue, Family Medicine, Dorchester, MA 02124 | 2005-07-28 |
| Find all providers in DORCHESTER | ||||
| City | DORCHESTER |
| Zip Code | 02125 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.