Individual provider Active NPI

Kelly Ann Rivera, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Worcester, MA
National Provider Identifier
1134900012
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
RN205716 Issued in MA
Practice address
435 Shrewsbury St
Worcester, MA 01604-1689
Phone
(508) 753-5554
NPI assigned
Oct 9, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN205716 MA Primary

Addresses

Primary practice location

435 Shrewsbury St
Worcester, MA 01604-1689

Mailing address

435 Shrewsbury St
Worcester, MA 01604-1689
Phone (508) 753-5554

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
I20231226000508 MA Practitioner - Nurse Practitioner 9335599828 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Behavioral Healthcare ServicesGroup PAC ID 3779818828, 26 clinicians

Practice addresses (Care Compare)

435 Shrewsbury St
Worcester, MA 01604-1689
Phone 5087535554110

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Behavioral Healthcare Services CurrentSince Oct 19, 2023 Accepting new patients
Kelly a Rivera, LLC Psychiatric/Mental Health Past Accepting new patients

Locations

435 Shrewsbury St
Worcester, MA 01604
Phone (508) 577-2017

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.

NPI Registry JSON

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

{
    "created_epoch": "1696809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1134900012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 SHREWSBURY ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016041689",
            "telephone_number": "508-753-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 SHREWSBURY ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016041689",
            "telephone_number": "508-753-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-09",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN205716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.