Marybeth S Kelly, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1150 Issued in MA

Practice address

75 Springfield Rd
Suite 1 Family Medicine Assoc
Westfield, MA 01085

Phone

(413) 562-5173

Fax

(413) 562-1716

NPI assigned

Jul 21, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Ms. Marybeth S Markham Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Mercy Inpatient Medical Associates Inc.

  • Internal Medicine Physician
  • Springfield, MA
  • NPI 1407845282
  NPD (past)
• Western Mass Physician Associates Inc

  • Obstetrics & Gynecology Physician
  • Chicopee, MA
  • NPI 1922009547
  NPD (past)

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199318400000",
    "number": "1235139130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 SPRINGFIELD RD",
            "address_2": "SUITE 1 FAMILY MEDICINE ASSOC",
            "city": "WESTFIELD",
            "state": "MA",
            "postal_code": "01085",
            "telephone_number": "413-562-5173",
            "fax_number": "413-562-1716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 SPRINGFIELD RD",
            "address_2": "SUITE 1 FAMILY MEDICINE ASSOC",
            "city": "WESTFIELD",
            "state": "MA",
            "postal_code": "01085",
            "telephone_number": "413-562-5173",
            "fax_number": "413-562-1716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MARYBETH",
        "middle_name": "S",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-21",
        "last_updated": "2008-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "1150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE OF MA",
            "identifier": "011500",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEECH STREET",
            "identifier": "21237210422",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARYBETH",
            "last_name": "MARKHAM",
            "middle_name": "S",
            "prefix": "MS.",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christine M Keenan, LDN
• Joseph P Keenan, M.D.
• Meghan Abigail Kelley
• Kelly Burek DPM PC
• Kelly D Burek DPM PC
• Tamie Kelsey-West, LMHC
• Jennifer Kendall
• Shantilal Kenia, M.D., FACC
• Kens'Eyewear Inc.
• Angela Kentish

• Physician Assistant in Westfield, MA
• Providers in Westfield, MA by specialty
• Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.