Individual provider Active NPI

Kaiming Chiang, PA

  • Physician Assistant
  • Haverhill, MA
National Provider Identifier
1013254366
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA4628 Issued in MA
Practice address
140 Lincoln Ave
Haverhill, MA 01830-6700
Phone
(978) 374-2000
Fax
(781) 828-2471
NPI assigned
Jan 7, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 PA4628 MA Primary

Addresses

Primary practice location

140 Lincoln Ave
Haverhill, MA 01830-6700

Mailing address

79 Wistaria St
West Springfield, MA 01089-2244
Phone (413) 459-6565

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NH2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20130708000669 MA Practitioner - Physician Assistant 0143460535 Reassigns benefits to 8 organizations
I20190122003061 NH Practitioner - Physician Assistant 0143460535

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1416NHMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Athol Memorial Hospital Incorporated Physician Assistant CurrentSince Jan 1, 2020 Accepting new patients
Lawrence General Hospital CurrentSince Dec 22, 2017 Accepting new patients
Henry Heywood Memorial Hospital Physician Assistant CurrentSince Jan 1, 2020 Accepting new patients

Locations

2033 Main St
Athol, MA 01331
Phone (978) 249-1295

242 Green St
Gardner, MA 01440
Phone (978) 258-4734

250 Green St
Gardner, MA 01440
Phone (978) 630-5050

242 Green St
Ste 205
Gardner, MA 01440

140 Lincoln Ave
Haverhill, MA 01830
Phone (978) 374-2000

1 General St
Lawrence, MA 01841
Phone (978) 946-8103

Organizations & group practices 8

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": "1357516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1013254366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 WISTARIA ST",
            "city": "WEST SPRINGFIELD",
            "state": "MA",
            "postal_code": "010892244",
            "telephone_number": "413-459-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 LINCOLN AVE",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "018306700",
            "telephone_number": "978-374-2000",
            "fax_number": "781-828-2471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHIANG",
        "first_name": "KAIMING",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-01-07",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA4628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Haverhill, MA

Sources for this page

Verify at the official NPI Registry.