NPIMap

Individual provider Active NPI

Kelley Susan Gillis, PA-C

  • Medical Physician Assistant
  • Boston, MA
National Provider Identifier
1265533137
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
0525 Issued in NH
Practice address
MGH Beacon Hill Primary Care
165 Cambridge St #501
Boston, MA 02114
Phone
(617) 726-4900
NPI assigned
Sep 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 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 PA4400 MA
Medical Physician Assistant 363AM0700X 0525 NH Primary

Addresses

Primary practice location

MGH Beacon Hill Primary Care
165 Cambridge St #501
Boston, MA 02114

Mailing address

2300 Southwood Dr
Dartmouth Hitchcock - Urgent Care
Nashua, NH 03063-1818
Phone (603) 577-4188

Other practice location 1

2300 Southwood Dr
Dartmouth Hitchcock - Urgent Care
Nashua, NH 03063-1818
Phone (603) 577-4188

Other identifiers 1

IdentifierTypeStateIssuer
30334240MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH, MA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060426000355 NH Practitioner - Physician Assistant 2062422702 Reassigns benefits to 2 organizations
I20130320000539 MA Practitioner - Physician Assistant 2062422702 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mary Hitchcock Memorial HospitalGroup PAC ID 4486561164, 1,269 clinicians

Practice addresses (Care Compare)

1 Medical Ctr Dr
Lebanon, NH 03756-1000
Phone (603) 650-5000

2300 Southwood Dr
Nashua, NH 03063-1818
Phone (603) 577-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Hitchcock Memorial Hospital CurrentSince Jun 1, 2023 Accepting new patients
Dartmouth-Hitchcock Clinic CurrentSince Jun 6, 2016 Accepting new patients
General Hospital Corp Current Accepting new patients
Massachusetts General Physicians Organization Inc CurrentSince May 13, 2024 Accepting new patients
Mary Hitchcock Memorial Hospital CurrentSince Jun 1, 2023 Accepting new patients
The Lowell General Hospital Past Accepting new patients
LGH Professional Services LLC Past Accepting new patients
DO Not Use - the Lowell General Hospital Past Accepting new patients
LGH Physician Associates, Inc Past Accepting new patients

Locations

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

165 Cambridge St
Ste 501
Boston, MA 02114
Phone (617) 726-4600

55 Fruit St
Boston, MA 02114

1 Medical Dr
Lebanon, NH 03756
Phone (603) 650-5922

2300 Southwood Dr
Nashua, NH 03063
Phone (603) 577-4170

Interoperability endpoints

  • Direct secure messaging: kgillis236741@direct.dartmouth-hitchcock.org
  • Direct secure messaging: kelley.gillis@urgentcare.circlehealthdirect.org
  • Direct secure messaging: gillis.kelley.mgh@direct.partners.masshiway.net
  • FHIR API: https://fhir-myrecord.cerner.com/r4/d04f75c7-2a62-4686-b520-7bf0635f38f0/

Organizations & group practices 12

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 6

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": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1265533137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 SOUTHWOOD DR",
            "address_2": "DARTMOUTH HITCHCOCK - URGENT CARE",
            "city": "NASHUA",
            "state": "NH",
            "postal_code": "030631818",
            "telephone_number": "603-577-4188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MGH BEACON HILL PRIMARY CARE",
            "address_2": "165 CAMBRIDGE ST #501",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02114",
            "telephone_number": "617-726-4900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2300 Southwood Dr",
            "address_2": "Dartmouth Hitchcock - Urgent Care",
            "address_purpose": "LOCATION",
            "city": "Nashua",
            "state": "NH",
            "postal_code": "030631818",
            "country_code": "US",
            "telephone_number": "603-577-4188",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLIS",
        "first_name": "KELLEY",
        "middle_name": "SUSAN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA4400",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NH",
            "license": "0525",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30334240",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.