Active NPI
Kevin Joseph Anderson
- Counselor
- Roxbury, MA
National Provider Identifier
1134556624
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- S40107772
- Practice address
- 520 Dudley St
Roxbury, MA 02119-2769 - Phone
- (508) 208-4656
- NPI assigned
- Sep 30, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | S40107772 | MA | Primary |
Addresses
Primary practice location
520 Dudley St
Roxbury, MA 02119-2769
Mailing address
520 Dudley St
Roxbury, MA 02119-2769
Phone (617) 445-6655
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000023532 | Other | MA | BMC |
| 042611055 | Other | MA | TAX ID |
| 1303287 | Medicaid | MA | |
| 99618201 | Other | MA | NETWORTH HEALTH |
| M18633 | Other | MA | BCBS |
| 1004745 | Other | MA | NHP |
| 1303287 | Other | MA | MBHP |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S40107772 | MA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384473600000",
"number": "1134556624",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "520 DUDLEY ST",
"city": "ROXBURY",
"state": "MA",
"postal_code": "021192769",
"telephone_number": "617-445-6655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 DUDLEY ST",
"city": "ROXBURY",
"state": "MA",
"postal_code": "021192769",
"telephone_number": "508-208-4656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "KEVIN",
"middle_name": "JOSEPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-09-30",
"last_updated": "2013-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MA",
"license": "S40107772",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BMC",
"identifier": "0000023532",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "042611055",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1303287",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NETWORTH HEALTH",
"identifier": "99618201",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "M18633",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NHP",
"identifier": "1004745",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MBHP",
"identifier": "1303287",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roxbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.