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ROOSEVELT LEWIS III NP
NPI 1649798133
Nurse Practitioner - Psychiatric/Mental Health in Boston, MA

Active since September 05, 2017Opted out of Medicare · through Apr 16, 2028
1208 VFW PKWY STE 301, BOSTON, MA 02132(617) 401-7441(617) 203-6651 Get Directions Write a Review

NPPES record last updated: January 5, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jan 5, 2021, Nov 10, 2018, Sep 3, 2018 (3 updates tracked since 2018).

About Roosevelt Lewis Iii Np NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ROOSEVELT LEWIS III NP (NPI 1649798133) is an individual psychiatric/mental health provider in Boston, Massachusetts, licensed in Massachusetts (RN2313246) and active in the NPI registry since September 2017. He has opted out of Medicare through April 16, 2028 and maintains a secondary practice location in Boston.

NPPES Registry Identity

NPI1649798133
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameROOSEVELT LEWIS IIICredential: NP
Location Address1208 VFW PKWY STE 301Boston, MA 02132-4344
Mailing Address1208 Vfw Pkwy Ste 301Boston, MA 02132-4344 · (617) 401-7441 · Fax (617) 203-6651
Phone(617) 401-7441
Fax(617) 203-6651
Sole ProprietorYes
Enumeration DateSeptember 5, 2017
Last NPPES UpdateJanuary 5, 20213 updates tracked since enumeration
NPPES CertifiedJanuary 5, 2021
✔ NPI 1649798133 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in MA · RN2313246
Also ListedRegistered NurseTaxonomy 163W00000X · License RN2313246 (MA)
1208 VFW PKWY STE 301, Boston, MA 02132
Open in Google Maps ↗

Secondary Practice Location 1

Location 11208 Vfw Pkwy Ste 301Boston, MA 02132-4344 · Phone (617) 401-7441 ext. 101 · Fax (617) 203-6651

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Roosevelt Lewis Iii Np has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 16, 2022 through April 16, 2028.

Opt-Out Effective DateApril 16, 2022
Opt-Out In Effect ThroughApril 16, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

UNITAS HEALTHCARE SYSTEMS, LLC
Clinic/Center (Mental Health (Including Community Mental Health Center))
1208 VFW PKWY STE 301
BOSTON, MA 02132
Suffolk County (617) 401-7441

Frequently Asked Questions

What is Roosevelt Lewis's NPI number?

The NPI number assigned to this healthcare provider is 1649798133, enumerated as an "individual" on September 05, 2017.

Where is the provider located?

The provider is located at 1208 VFW PKWY STE 301 BOSTON, MA 02132 and the phone number is (617) 401-7441.

What is the provider's specialty?

Nurse Practitioner with taxonomy code 363LP0808X and a focus in Psychiatric/Mental Health.