NPIMap

Individual provider Active NPI

Jeffrey J Kellogg, PA, MBA

  • Medical Physician Assistant
  • Lanesborough, MA
National Provider Identifier
1215925011
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1520 Issued in MA
Practice address
20 Williamstown Rd
Lanesborough, MA 01237-9548
Phone
(413) 455-6800
Fax
(833) 948-3572
NPI assigned
Oct 6, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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 1520 MA
Medical Physician Assistant 363AM0700X 1520 MA Primary

Addresses

Primary practice location

20 Williamstown Rd
Lanesborough, MA 01237-9548

Mailing address

26 Stormview Rd
Lanesborough, MA 01237-9732
Phone (413) 441-1921

Other practice location 1

421 N Main St
Leeds, MA 01053-9764
Phone (413) 584-4040 ext. 6363

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
I20040802000518 MA Practitioner - Physician Assistant 3971574344 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

20 Williamstown Rd
Suite 4
Lanesborough, MA 01237-9548
Phone (413) 445-6800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Business Administration, Physician Assistant

State licenses

LicenseStateTypeSpecialty
1520MAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Hospital Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jeffrey.kellogg.1@29021.direct.athenahealth.com

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 7

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": "1128556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1215925011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 STORMVIEW RD",
            "city": "LANESBOROUGH",
            "state": "MA",
            "postal_code": "012379732",
            "telephone_number": "413-441-1921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 WILLIAMSTOWN RD",
            "city": "LANESBOROUGH",
            "state": "MA",
            "postal_code": "012379548",
            "telephone_number": "413-455-6800",
            "fax_number": "833-948-3572"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "421 N Main St",
            "address_purpose": "LOCATION",
            "city": "Leeds",
            "state": "MA",
            "postal_code": "010539764",
            "country_code": "US",
            "telephone_number": "413-584-4040 x6363",
            "fax_number": "508-425-2515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLOGG",
        "first_name": "JEFFREY",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "PA, MBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-06",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "1520",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "1520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lanesborough, MA

Sources for this page

Verify at the official NPI Registry.