Individual provider Active NPI

Keisha Mungal, FNP

  • Family Nurse Practitioner
  • Boston, MA
National Provider Identifier
1063168284
Registry record updated Jun 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F002221067 Issued in MA
Practice address
800 Washington St, South 7
Boston, MA 02111
Phone
(617) 636-1227
NPI assigned
Feb 25, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F002221067 MA Primary

Addresses

Primary practice location

800 Washington St, South 7
Boston, MA 02111

Mailing address

800 Washington St, South 7
Boston, MA 02111
Phone (617) 636-1227

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kmungal@tuftsmedicalcenter.org

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
I20220623001259 MA Practitioner - Nurse Practitioner 8022497908 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pratt Medical Group IncGroup PAC ID 3375515661, 282 clinicians

Practice addresses (Care Compare)

800 Washington St
Boston, MA 02111-1552
Phone (617) 636-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F002221067MAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pratt Medical Group, Inc CurrentSince Apr 17, 2022 Accepting new patients
Pratt Medical Group, Inc Current Accepting new patients
Pratt Medical Group, Inc CurrentSince Apr 17, 2022 Accepting new patients
Pratt Medical Group, Inc Past Accepting new patients

Locations

800 Washington St
Boston, MA 02111
Phone (617) 636-4800

800 Washington St
#7
Boston, MA 02111
Phone (617) 636-1227

800 Washington St
#1
Boston, MA 02111

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 1

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": "1645747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654819200000",
    "number": "1063168284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 WASHINGTON ST, SOUTH 7",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02111",
            "telephone_number": "617-636-1227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 WASHINGTON ST, SOUTH 7",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02111",
            "telephone_number": "617-636-1227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNGAL",
        "first_name": "KEISHA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-25",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "F002221067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmungal@tuftsmedicalcenter.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "800 Washington St, South 7",
            "city": "Boston",
            "state": "MA",
            "country_code": "US",
            "postal_code": "02111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.