Kristin K. Wickstrom, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2210 Issued in MA

Practice address

151 Worcester Rd
Barre Family Health Center
Barre, MA 01005-9002

Phone

(978) 355-6321

Fax

(978) 355-6329

NPI assigned

Jan 12, 2007

Sex

Female

Sole proprietor

No

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.

• Umass Memorial Medical Group Inc

  • Internal Medicine Physician
  • Worcester, MA
  • NPI 1760445373

  MA

  Medicare reassignment Care Compare group
• Virtucare Harmony

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fitchburg, MA
  • NPI 1033994637

  MA

  Medicare reassignment
• Umass Memorial Medical Group, Inc.

  • Urgent Care Clinic/Center
  • Oxford, MA
  • NPI 1982381018
  NPD

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

• Umass Memorial Health-Harrington Hospital Inc

  • General Acute Care Hospital
  • Southbridge, MA
  • NPI 1790780047

  Hospital

  Care Compare affiliation
• Umass Memorial Healthalliance Clinton Hospital Inc

  • General Acute Care Hospital
  • Leominster, MA
  • NPI 1013995133

  Hospital

  Care Compare affiliation
• Umass Memorial Healthalliance Clinton Hospital Inc

  • Psychiatric Hospital Unit
  • Clinton, MA
  • NPI 1285171934

  Hospital

  Care Compare affiliation
• Umass Memorial Medical Center, Inc.

  • General Acute Care Hospital
  • Worcester, MA
  • NPI 1831151455

  Hospital

  Care Compare affiliation

Specialty

Physician Assistant

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Umass Memorial Medical Group Inc 2,494 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Umass Memorial Medical Center/University Campus Hospital, Worcester, MA, CCN 220163
• Umass Memorial Health - Harrington Hospital Hospital, Southbridge, MA, CCN 220019
• Umass Memorial Healthalliance Hospitals Hospital, Leominster, MA, CCN 220001

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kwickstrom23988@umassmemorial.direct-ci.com

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 24, 2020.

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603497600000",
    "number": "1053461632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348",
            "telephone_number": "800-225-8885",
            "fax_number": "508-334-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 WORCESTER RD",
            "address_2": "BARRE FAMILY HEALTH CENTER",
            "city": "BARRE",
            "state": "MA",
            "postal_code": "010059002",
            "telephone_number": "978-355-6321",
            "fax_number": "978-355-6329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKSTROM",
        "first_name": "KRISTIN",
        "middle_name": "K.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-12",
        "last_updated": "2020-10-24",
        "certification_date": "2020-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA2210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwickstrom23988@UmassMemorial.direct-ci.com",
            "affiliation": "N",
            "address_1": "151 Worcester Rd",
            "address_2": "Barre Family Health Center",
            "city": "Barre",
            "state": "MA",
            "country_code": "US",
            "postal_code": "010059002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "151 Worcester Rd",
            "address_2": "Barre Family Health Center",
            "city": "Barre",
            "state": "MA",
            "country_code": "US",
            "postal_code": "010059002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Town of Barre
• Noah Welker
• Rise Alexandra Werfel Cuff
• Cheryl Wheeler
• Madeleine Whitaker, DO
• Randal Williams, MA
• Melissa L Wojtkowski, MS
• Sarah Yoder, MD
• Anqi Zhou, MD

• All providers in Barre, MA
• Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.