Individual provider Active NPI

Jaya Rawla, CNP

  • Gerontology Nurse Practitioner
  • Springfield, MA
National Provider Identifier
1043783608
Registry record updated Aug 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
RN2328557 Issued in MA
Practice address
380 Plainfield St
Springfield, MA 01107-1524
Phone
(413) 794-4458
Fax
(413) 794-5131
NPI assigned
Jan 7, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN2328557 MA
Primary Care Nurse Practitioner 363LP2300X RN2328557 MA
Gerontology Nurse Practitioner 363LG0600X RN2328557 MA Primary

Addresses

Primary practice location

380 Plainfield St
Springfield, MA 01107-1524

Mailing address

280 Chestnut St FL 2
Springfield, MA 01199-1001
Phone (413) 794-5700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20210222001115 MA Practitioner - Nurse Practitioner 0446665632 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Massachusetts Medical School, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baystate Medical Practices IncGroup PAC ID 5991602971, 1,350 clinicians

Practice addresses (Care Compare)

280 Chestnut St
Suite 2
Springfield, MA 01199-1001

380 Plainfield St
Springfield, MA 01107-1524
Phone (413) 794-4458

759 Chestnut St
Springfield, MA 01199-1001
Phone (413) 794-5439

Hospital & facility affiliations

  • Baystate Medical Center Hospital, Springfield, MA, CCN 220077

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Edward M. Kennedy Community Health Center, Inc CurrentSince Feb 15, 2021 Accepting new patients
Edward M. Kennedy Community Health Center, Inc CurrentSince Feb 15, 2021 Accepting new patients
Baystate Medical Practices, Inc CurrentSince Jun 16, 2022 Accepting new patients

Locations

354 Waverley St
Framingham, MA 01702
Phone (508) 270-5700

759 Chestnut St
Springfield, MA 01199
Phone (413) 794-3233

280 Chestnut St
Fl 2
Springfield, MA 01199
Phone (413) 788-4385

380 Plainfield St
Springfield, MA 01107
Phone (413) 794-4458

19 Tacoma St
Worcester, MA 01605
Phone (508) 854-2122

650 Lincoln St
Worcester, MA 01605
Phone (508) 532-7318

Organizations & group practices 3

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 2

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": "1546819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1043783608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 CHESTNUT ST FL 2",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011991001",
            "telephone_number": "413-794-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 PLAINFIELD ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011071524",
            "telephone_number": "413-794-4458",
            "fax_number": "413-794-5131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAWLA",
        "first_name": "JAYA",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-07",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MA",
            "license": "RN2328557",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MA",
            "license": "RN2328557",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MA",
            "license": "RN2328557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MA

Sources for this page

Verify at the official NPI Registry.