Active NPI
Edith Sanborn Kaselis, MD
- Pediatrics Physician
- Yarmouth Port, MA
National Provider Identifier
1124081625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 75612
- Practice address
- 179 Route 6a
Yarmouth Port, MA 02675-1714 - Phone
- (508) 833-0269
- Fax
- (508) 833-1467
- NPI assigned
- Apr 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 75612 | MA | Primary |
Addresses
Primary practice location
179 Route 6a
Yarmouth Port, MA 02675-1714
Mailing address
179 Route 6a
Yarmouth Port, MA 02675-1714
Phone (508) 833-0269
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3106438 | Medicaid | MA | |
| J13603 | Other | MA | BLUE CROSS |
| CIGNA | Other | MA | CIGNA |
| 728557 | Other | MA | TUFTS HEALTH PLAN |
| 20844 | Other | MA | HARVARD PILGRIM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 75612 | MA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Briarpatch Pediatrics | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- ekaselis13282@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 and National Provider Directory roles.
-
- Pediatrics Physician
- Sandwich, MA
- NPI 1073678157
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320019200000",
"number": "1124081625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "179 ROUTE 6A",
"city": "YARMOUTH PORT",
"state": "MA",
"postal_code": "026751714",
"telephone_number": "508-833-0269",
"fax_number": "508-833-1467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "179 ROUTE 6A",
"city": "YARMOUTH PORT",
"state": "MA",
"postal_code": "026751714",
"telephone_number": "508-833-0269",
"fax_number": "508-833-1467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KASELIS",
"first_name": "EDITH",
"middle_name": "SANBORN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-07",
"last_updated": "2011-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MA",
"license": "75612",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3106438",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "J13603",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "CIGNA",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "728557",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "20844",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yarmouth Port, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.