Individual provider Active NPI

Mark Thomas Kestner, PA

  • Physician Assistant
  • Medford, MA
National Provider Identifier
1053863662
Registry record updated Jan 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA6008 Issued in MA
Practice address
44 Manning St
Medford, MA 02155-4422
Phone
(602) 315-0423
NPI assigned
Oct 30, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2017

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 PA6008 MA Primary

Addresses

Primary practice location

44 Manning St
Medford, MA 02155-4422

Mailing address

44 Manning St
Medford, MA 02155-4422
Phone (602) 315-0423

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
I20180102001106 MA Practitioner - Physician Assistant 8325306020 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1 Hutchinson Dr
Danvers, MA 01923-3748
Phone (978) 739-6950

1285 Beacon St
Brookline, MA 02446-5237
Phone (888) 980-0505

137 Stuart St
Suite a 7
Boston, MA 02116-5609
Phone (888) 980-0505

425 Washington St
Woburn, MA 01801-2157
Phone (781) 285-7955

480 Lynnfield St
Lynn, MA 01904-1419
Phone (781) 593-3400

71 Needham St
Newton, MA 02461-1663
Phone (857) 598-4460

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA6008MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mass General Brigham Urgent Care LLC Current Accepting new patients
Mass General Brigham Urgent Care LLC CurrentSince Nov 1, 2017 Accepting new patients
Mass General Brigham Urgent Care LLC CurrentSince Nov 1, 2017 Accepting new patients

Locations

1285 Beacon St
Brookline, MA 02446
Phone (617) 751-6205

3711 S Mopac Expy
Bldg 2
Austin, TX 78746

Interoperability endpoints

  • Direct secure messaging: kestner.mark.puc@direct.partners.masshiway.net

Organizations & group practices 4

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 3

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": "1477785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485820800000",
    "number": "1053863662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 MANNING ST",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021554422",
            "telephone_number": "602-315-0423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 MANNING ST",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021554422",
            "telephone_number": "602-315-0423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KESTNER",
        "first_name": "MARK",
        "middle_name": "THOMAS",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-30",
        "last_updated": "2017-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA6008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, MA

Sources for this page

Verify at the official NPI Registry.