Individual provider Active NPI

Paola Buchanan, NP

  • Adult Health Nurse Practitioner
  • Pembroke, MA
National Provider Identifier
1104423482
Registry record updated Oct 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
RN2311166 Issued in MA
Practice address
15 Old West Elm St
Pembroke, MA 02359-1731
Phone
(781) 924-5980
NPI assigned
Oct 8, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X RN2311166 MA
Adult Health Nurse Practitioner 363LA2200X RN2311166 MA Primary

Addresses

Primary practice location

15 Old West Elm St
Pembroke, MA 02359-1731

Mailing address

1107 Washington St
Walpole, MA 02081-4143

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
I20210504001033 MA Practitioner - Nurse Practitioner 1850700865 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Massachusetts Medical School, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pembroke Medical Associates IncGroup PAC ID 3678992955, 26 clinicians

Practice addresses (Care Compare)

15 Old W Elm St
Pembroke, MA 02359-1731
Phone (781) 202-9292

Hospital & facility affiliations

  • South Shore Hospital Hospital, South Weymouth, MA, CCN 220100

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN2311166MAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pai Participant Ma PC CurrentSince Nov 27, 2023 Accepting new patients

Locations

111 Orient Ave
East Boston, MA 02128
Phone (617) 569-1200

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 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": "1602115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633564800000",
    "number": "1104423482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 WASHINGTON ST",
            "city": "WALPOLE",
            "state": "MA",
            "postal_code": "020814143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 OLD WEST ELM ST",
            "city": "PEMBROKE",
            "state": "MA",
            "postal_code": "023591731",
            "telephone_number": "781-924-5980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCHANAN",
        "first_name": "PAOLA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-08",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MA",
            "license": "RN2311166",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "RN2311166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke, MA

Sources for this page

Verify at the official NPI Registry.