Individual provider Active NPI

Kimberly J Adamson, CPNP

  • Pediatric Nurse Practitioner
  • Holden, MA
National Provider Identifier
1063494995
Registry record updated Mar 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
235904 Issued in MA
Practice address
64 Boyden Rd
Holden, MA 01520-2570
Phone
(508) 885-2003
Fax
(508) 885-8071
NPI assigned
Nov 16, 2005
Last updated
Mar 21, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 235904 MA Primary

Addresses

Primary practice location

64 Boyden Rd
Holden, MA 01520-2570

Mailing address

64 Boyden Rd
Holden, MA 01520-2570
Phone (508) 885-2003

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100720000840 MA Practitioner - Nurse Practitioner 5294867644 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
235904MAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Reliant Medical Group, Inc CurrentSince Feb 21, 2024 Accepting new patients
Reliant Medical Group, Inc Past Accepting new patients

Locations

64 Boyden Rd
Holden, MA 01520
Phone (508) 829-6765

5 Neponset St
Worcester, MA 01606
Phone (508) 595-2300

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HFGIBD/Endpoint/HFGIBD

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710979200000",
    "number": "1063494995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 BOYDEN RD",
            "city": "HOLDEN",
            "state": "MA",
            "postal_code": "015202570",
            "telephone_number": "508-885-2003",
            "fax_number": "508-885-8071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 BOYDEN RD",
            "city": "HOLDEN",
            "state": "MA",
            "postal_code": "015202570",
            "telephone_number": "508-885-2003",
            "fax_number": "508-885-8071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADAMSON",
        "first_name": "KIMBERLY",
        "middle_name": "J",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-16",
        "last_updated": "2024-03-21",
        "certification_date": "2024-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MA",
            "license": "235904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holden, MA

Sources for this page

Verify at the official NPI Registry.