NPIMap

Organization Active NPI

Kellie Berry Nutrition Inc

  • Registered Dietitian
  • Chelmsford, MA
National Provider Identifier
1275982605
Registry record updated Jun 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
KELLIE BERRY NUTRITION INC
Practice address
2 Courthouse LN
Suite 10
Chelmsford, MA 01824-1715
Phone
(978) 408-8812
NPI assigned
Jun 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2016

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

Authorized official

Name
Kellie Berry, RDNPI 1639592629
Title
Owner
Phone
(978) 408-8812

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X Primary

Addresses

Primary practice location

2 Courthouse LN
Suite 10
Chelmsford, MA 01824-1715

Mailing address

2 Courthouse LN
Suite 10
Chelmsford, MA 01824-1715
Phone (978) 408-8812

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221109000551 MA Part B Supplier - Clinic/Group Practice 9739556465 Receives reassigned benefits from 3 practitioners
Practice locations: Chelmsford, MA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1465257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465257600000",
    "number": "1275982605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 COURTHOUSE LN",
            "address_2": "SUITE 10",
            "city": "CHELMSFORD",
            "state": "MA",
            "postal_code": "018241715",
            "telephone_number": "978-408-8812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 COURTHOUSE LN",
            "address_2": "SUITE 10",
            "city": "CHELMSFORD",
            "state": "MA",
            "postal_code": "018241715",
            "telephone_number": "978-408-8812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLIE BERRY NUTRITION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-07",
        "last_updated": "2016-06-07",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "978-408-8812",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chelmsford, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.