Individual provider Active NPI

Nicole Isabel Love

  • Physician Assistant
  • Revere, MA
National Provider Identifier
1144866427
Registry record updated Jan 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA7824 Issued in MA
Practice address
454 Broadway
Revere, MA 02151-3034
Phone
(781) 485-8222
NPI assigned
Nov 21, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X PA7824 MA Primary

Addresses

Primary practice location

454 Broadway
Revere, MA 02151-3034

Mailing address

454 Broadway
Revere, MA 02151-3034

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
I20210524001520 MA Practitioner - Physician Assistant 3779982731 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cambridge Public Health CommissionGroup PAC ID 8921910894, 654 clinicians

Practice addresses (Care Compare)

103 Garland St
Everett, MA 02149-5066
Phone (617) 389-6270

1493 Cambridge St
Cambridge, MA 02139-1047
Phone (617) 665-1000

454 Broadway
Revere, MA 02151-3034
Phone (781) 485-8222

Hospital & facility affiliations

  • Cambridge Health Alliance Hospital, Cambridge, MA, CCN 220011

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cambridge Public Health Commission CurrentSince Feb 19, 2021 Accepting new patients
Cambridge Public Health Commission CurrentSince Feb 19, 2021 Accepting new patients

Locations

1493 Cambridge St
Cambridge, MA 02139
Phone (617) 665-1185

103 Garland St
Everett, MA 02149
Phone (617) 381-7150

454 Broadway
Revere, MA 02151
Phone (617) 389-4666

Interoperability endpoints

  • Direct secure messaging: nlove110630@direct.challiance.masshiway.net

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1574294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642032000000",
    "number": "1144866427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "454 BROADWAY",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021513034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "454 BROADWAY",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021513034",
            "telephone_number": "781-485-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOVE",
        "first_name": "NICOLE",
        "middle_name": "ISABEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-21",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA7824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Revere, MA

Sources for this page

Verify at the official NPI Registry.