Individual provider Active NPI

Katherine Hendren Rose, MD

  • Student in an Organized Health Care Education/Training Program
  • Worcester, MA
National Provider Identifier
1093344467
Registry record updated May 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
55 Lake Avenue North
Worcester, MA 01655
Phone
(508) 856-3590
Fax
(508) 856-1031
NPI assigned
Apr 7, 2020
Last updated
May 4, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

55 Lake Avenue North
Worcester, MA 01655

Mailing address

55 Lake Avenue North
Worcester, MA 01655
Phone (508) 856-3590

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200929002259 MA Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 4587083233

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
East Milton Pediatrics Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: krose38230@direct.chppoc.masshiway.net

Organizations & group practices 1

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": "1586217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588550400000",
    "number": "1093344467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 LAKE AVENUE NORTH",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "01655",
            "telephone_number": "508-856-3590",
            "fax_number": "508-856-1031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAKE AVENUE NORTH",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "01655",
            "telephone_number": "508-856-3590",
            "fax_number": "508-856-1031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "KATHERINE",
        "middle_name": "HENDREN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-07",
        "last_updated": "2020-05-04",
        "certification_date": "2020-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.