Individual provider Active NPI

Kylie Altavesta, PA-C

  • Physician Assistant
  • Concord, MA
National Provider Identifier
1235776832
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
330 Baker Ave
Concord, MA 01742-2129
Phone
(978) 287-9350
NPI assigned
Dec 3, 2019
Last updated
Jun 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

330 Baker Ave
Concord, MA 01742-2129

Mailing address

330 Baker Ave
Concord, MA 01742-2129
Phone (978) 287-9350

Other names 1

  • Kylie McCaul Former name

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210503001426 MA Practitioner - Physician Assistant 4981013042 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
Atrius Health IncGroup PAC ID 4789588641, 1,214 clinicians

Practice addresses (Care Compare)

100 2ND Ave
Needham, MA 02494-2809
Phone (781) 726-4800

133 Brookline Ave
Boston, MA 02215-3904
Phone (617) 421-1000

20 Wall St
Burlington, MA 01803-4758
Phone (781) 221-2500

228 Billerica Rd
Chelmsford, MA 01824-3604
Phone (978) 250-6000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Atrius Health, Inc. Physician Assistant CurrentSince Apr 26, 2021 Accepting new patients
Atrius Health, Inc. CurrentSince Apr 26, 2021 Accepting new patients

Locations

133 Brookline Ave
Boston, MA 02215
Phone (617) 421-1000

147 Milk St
Fl 9
Boston, MA 02109
Phone (617) 559-8051

330 Baker Ave
Concord, MA 01742
Phone (978) 287-9300

Interoperability endpoints

  • Direct secure messaging: kmccaul195043@direct.atrius.masshiway.net

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 1

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": "1575331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1235776832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 BAKER AVE",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017422129",
            "telephone_number": "978-287-9350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 BAKER AVE",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017422129",
            "telephone_number": "978-287-9350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALTAVESTA",
        "first_name": "KYLIE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-03",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYLIE",
            "last_name": "MCCAUL",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Concord, MA

Sources for this page

Verify at the official NPI Registry.