Individual provider Active NPI

Benjamin Killilea, PH.D.

  • Psychologist
  • Boston, MA
National Provider Identifier
1205140746
Registry record updated Oct 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
8993 Issued in MA
Practice address
75 Fenwood Rd
Boston, MA 02115-6103
Phone
(617) 626-9318
Fax
(617) 626-9531
NPI assigned
Jul 26, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 8993 MA Primary
Clinical Child & Adolescent Psychologist 103TC2200X

Addresses

Primary practice location

75 Fenwood Rd
Boston, MA 02115-6103

Mailing address

39 Botolph St
Quincy, MA 02171-1988
Phone (339) 987-0849

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141213000219 MA Practitioner - Clinical Psychologist 5799007126 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Commonwealth of MassachusettsGroup PAC ID 8820906860, 141 clinicians

Practice addresses (Care Compare)

365 E St
Tewksbury Hospital
Tewksbury, MA 01876-1998
Phone (978) 851-7321

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
8993MAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Commonwealth of Massachusetts CurrentSince May 1, 2016 Accepting new patients

Locations

365 East St
Tewksbury, MA 01876
Phone (617) 536-2186

Organizations & group practices 1

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": "1280102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383091200000",
    "number": "1205140746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 BOTOLPH ST",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021711988",
            "telephone_number": "339-987-0849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 FENWOOD RD",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156103",
            "telephone_number": "617-626-9318",
            "fax_number": "617-626-9531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILLILEA",
        "first_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-26",
        "last_updated": "2013-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "8993",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.