NPIMap

Individual provider Active NPI

Kelley Ann Prendergast, PA

  • Physician Assistant
  • Gardner, MA
National Provider Identifier
1033189352
Registry record updated Oct 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
AP2003 Issued in MA
Practice address
175 Connors Street
Gardner, MA 01440
Phone
(978) 410-6121
Fax
(978) 410-6109
NPI assigned
Jan 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2015

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 AP2003 MA Primary

Addresses

Primary practice location

175 Connors Street
Gardner, MA 01440

Mailing address

326 Nichols Road
Fitchburg, MA 01420
Phone (978) 878-8100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140904000859 MA Practitioner - Physician Assistant 6608094644 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
May accept Medicare assignment
Group practices
Community Health Connections, IncGroup PAC ID 8729074992, 91 clinicians

Practice addresses (Care Compare)

175 Connors St
Gardner, MA 01440-2637
Phone (978) 410-6100

326 Nichols Rd
Fitchburg, MA 01420-1914
Phone (978) 878-8100

529 Timpany Blvd
Gardner, MA 01440-3451
Phone (978) 878-8100

Hospital & facility affiliations

  • Health Alliance Home Health and Hospice Home health agency, Leominster, MA, CCN 227009
  • Care Central Vna & Hospice Inc Home health agency, Gardner, MA, CCN 227003
  • Heywood Hospital - Hospital, Gardner, MA, CCN 220095
  • Umass Memorial Healthalliance Hospitals Hospital, Leominster, MA, CCN 220001
  • Athol Memorial Hospital Hospital, Athol, MA, CCN 221303

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
82.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP2003MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Connections, Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kelley.prendergast.p1@direct.chcfhc.nextgenshare.com

Organizations & group practices 2

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445990400000",
    "number": "1033189352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "326 NICHOLS ROAD",
            "city": "FITCHBURG",
            "state": "MA",
            "postal_code": "01420",
            "telephone_number": "978-878-8100",
            "fax_number": "978-878-8537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 CONNORS STREET",
            "city": "GARDNER",
            "state": "MA",
            "postal_code": "01440",
            "telephone_number": "978-410-6121",
            "fax_number": "978-410-6109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENDERGAST",
        "first_name": "KELLEY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-26",
        "last_updated": "2015-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "AP2003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardner, MA

Sources for this page

Verify at the official NPI Registry.