Individual provider Active NPI

Kristen Marie Looman, PA

  • Physician Assistant
  • Brighton, MA
National Provider Identifier
1205400439
Registry record updated Nov 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA8308 Issued in MA
Practice address
11 Nevins St Ste 403
Brighton, MA 02135-3514
Phone
(617) 789-2102
NPI assigned
May 12, 2021
Last updated
Nov 2, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X PA8308 MA Primary

Addresses

Primary practice location

11 Nevins St Ste 403
Brighton, MA 02135-3514

Mailing address

11 Nevins St Ste 403
Brighton, MA 02135-3514
Phone (617) 789-2102

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, DC, VA3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20211102002374 MA Practitioner - Physician Assistant 8527456078 Reassigns benefits to 2 organizations
I20240909000087 DC Practitioner - Physician Assistant 8527456078 Reassigns benefits to 1 organization
I20241114000834 VA Practitioner - Physician Assistant 8527456078 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Columbia Associates in Psychiatry PCGroup PAC ID 7113165739, 127 clinicians

Practice addresses (Care Compare)

10721 Main St
Fairfax, VA 22030-6902
Phone (571) 977-6870

2960 Sleepy Hollow Rd
Falls Church, VA 22044-2030
Phone (703) 536-2000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA8308MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Steward Medical Group, Inc CurrentSince Dec 1, 2021 Accepting new patients
Steward Medical Group, Inc CurrentSince Dec 1, 2021 Accepting new patients
Steward St. Elizabeth's Medical Center of Boston, Inc. CurrentSince Apr 22, 2024 Accepting new patients

Locations

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

11 Nevins St
Ste 403
Brighton, MA 02135
Phone (617) 254-1247

736 Cambridge St
Brighton, MA 02135
Phone (617) 789-2762

77 Warren St
Fl 1
Brighton, MA 02135
Phone (617) 562-5200

9 Galen St
Ste 155
Watertown, MA 02472
Phone (857) 304-2444

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1620777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1205400439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 NEVINS ST STE 403",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021353514",
            "telephone_number": "617-789-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 NEVINS ST STE 403",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021353514",
            "telephone_number": "617-789-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOOMAN",
        "first_name": "KRISTEN",
        "middle_name": "MARIE",
        "name_prefix": "Miss",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-12",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA8308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brighton, MA

Sources for this page

Verify at the official NPI Registry.