NPIMap

Individual provider Active NPI

Penelope Kagan

  • Internal Medicine Physician
  • Brockton, MA
National Provider Identifier
1194341008
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
1015538 Issued in MA
Practice address
1 Pearl St Ste 2100
Brockton, MA 02301-2868
Phone
(508) 897-6040
Fax
(508) 897-6045
NPI assigned
Jun 17, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 1015538 MA Primary

Addresses

Primary practice location

1 Pearl St Ste 2100
Brockton, MA 02301-2868

Mailing address

98 Bolton St
Boston, MA 02127-1106

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231027002009 MA Practitioner - Internal Medicine 3476977331 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Revere Medical of Massachusetts PCGroup PAC ID 0749715795, 113 clinicians
Steward Medical Group IncGroup PAC ID 2860688728, 23 clinicians

Practice addresses (Care Compare)

1 Pearl St
Suite 2100
Brockton, MA 02301-2868
Phone (508) 897-6050

1 Pearl St
Suite 2400
Brockton, MA 02301-2865
Phone (508) 897-6130

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Steward Medical Group, Inc CurrentSince Sep 13, 2023 Accepting new patients
Revere Medical of Massachusetts, PC Internal Medicine CurrentSince Oct 30, 2024 Accepting new patients
Steward Medical Group, Inc CurrentSince Sep 13, 2023 Accepting new patients

Locations

11 Nevins St
Ste 201
Brighton, MA 02135
Phone (617) 789-2442

1 Pearl St
Ste 21000
Brockton, MA 02301

1 Pearl St
Ste 2400
Brockton, MA 02301
Phone (508) 897-6050

1 Pearl St
Ste 2100
Brockton, MA 02301
Phone (508) 897-6040

1 Pearl St
Ste 1000
Brockton, MA 02301
Phone (508) 897-6050

15 Payson Rd
Ste 3
Foxboro, MA 02035
Phone (508) 772-1438

100 Amesbury St
Ste 103
Lawrence, MA 01840
Phone (978) 683-0157

9 Galen St
Watertown, MA 02472
Phone (617) 562-5413

Interoperability endpoints

  • Direct secure messaging: penelope.kagan.1@32866.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1592352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1194341008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98 BOLTON ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021271106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PEARL ST STE 2100",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023012868",
            "telephone_number": "508-897-6040",
            "fax_number": "508-897-6045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAGAN",
        "first_name": "PENELOPE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-17",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "1015538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.