Individual provider Active NPI

Emilia Higinbotham

  • Physician Assistant
  • Peabody, MA
National Provider Identifier
1104717156
Registry record updated Jul 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2 Pontiac Rd
Peabody, MA 01960-3320
Phone
(978) 587-6310
NPI assigned
Jul 9, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2025

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 Primary

Addresses

Primary practice location

2 Pontiac Rd
Peabody, MA 01960-3320

Mailing address

2 Pontiac Rd
Peabody, MA 01960-3320
Phone (978) 587-6310

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
I20251117003009 MA Practitioner - Physician Assistant 1254822349 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1 Roosevelt Ave
Suite 201
Peabody, MA 01960-2294

2 Pontiac Rd
Peabody, MA 01960-3320

330 Lynnway
Suite 109a
Lynn, MA 01901-1708

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Congenial Healthcare, LLC CurrentSince Dec 1, 2025 Accepting new patients
Congenial Healthcare, LLC CurrentSince Dec 1, 2025 Accepting new patients
Congenial Healthcare, LLC Current Accepting new patients

Locations

330 Lynnway
Ste 109A
Lynn, MA 01901
Phone (781) 593-6005

1 Roosevelt Ave
Ste 201
Peabody, MA 01960
Phone (978) 536-0215

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1752019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752019200000",
    "number": "1104717156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 PONTIAC RD",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019603320",
            "telephone_number": "978-587-6310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 PONTIAC RD",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019603320",
            "telephone_number": "978-587-6310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HIGINBOTHAM",
        "first_name": "EMILIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-09",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peabody, MA

Sources for this page

Verify at the official NPI Registry.