Active NPI
Stephen T Kenneson, PA
- Physician Assistant
- Boston, MA
National Provider Identifier
1124178967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 527
- Practice address
- Massachusetts General Hospital Cardiac Surgery
55 Fruit Street
Boston, MA 02114 - Phone
- (617) 726-1861
- NPI assigned
- Jan 12, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 527 | MA | Primary |
| Surgical Physician Assistant | 363AS0400X | 527 | MA |
Addresses
Primary practice location
Massachusetts General Hospital Cardiac Surgery
55 Fruit Street
Boston, MA 02114
Mailing address
163 Gleasondale Rd
Stow, MA 01775-1334
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 527 | MA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Massachusetts General Physicians Organization Inc | Current | Accepting new patients | |
| General Hospital Corp | Current | Accepting new patients |
Locations
55 Fruit St
Boston, MA 02114
55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967
Interoperability endpoints
- kenneson.stephen.mgh@direct.partners.masshiway.net
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.
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- NPI 1801874573
-
- General Acute Care Hospital
- Boston, MA
- NPI 1023049236
-
- General Acute Care Hospital
- Boston, MA
- NPI 1508390014
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1124178967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "163 GLEASONDALE RD",
"city": "STOW",
"state": "MA",
"postal_code": "017751334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MASSACHUSETTS GENERAL HOSPITAL CARDIAC SURGERY",
"address_2": "55 FRUIT STREET",
"city": "BOSTON",
"state": "MA",
"postal_code": "02114",
"telephone_number": "617-726-1861"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNESON",
"first_name": "STEPHEN",
"middle_name": "T",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-12",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MA",
"license": "527",
"primary": true
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "MA",
"license": "527",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.