NPIMap

Individual provider Active NPI

Keren Mariam John, PA- CERTIFIED

  • Physician Assistant
  • New London, CT
National Provider Identifier
1285190462
Registry record updated Aug 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-14522 Issued in NC
Practice address
365 Montauk Ave
New London, CT 06320-4700
Phone
(860) 442-0711
NPI assigned
Feb 13, 2019
Last updated
Aug 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2025

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 4523 CT
Physician Assistant 363A00000X 0010-14522 NC Primary

Addresses

Primary practice location

365 Montauk Ave
New London, CT 06320-4700

Mailing address

Community Health Center
675 Main Street
Middletown, CT 06457
Phone (516) 510-4160

Other names 1

  • Keren Mariam Paul Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, NC2 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
I20191022000421 CT Practitioner - Physician Assistant 6305178567 Reassigns benefits to 3 organizations
I20250312002803 NC Practitioner - Physician Assistant 6305178567 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fastmed PCGroup PAC ID 9830540558, 174 clinicians

Practice addresses (Care Compare)

6500 Creedmoor Rd
Suite 110
Raleigh, NC 27613-3698
Phone (919) 825-4000

7010 NC Hwy 751
Durham, NC 27707-5733
Phone (919) 313-3900

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Center Inc CurrentSince May 1, 2024 Accepting new patients
Northeast Medical Group, Inc. CurrentSince Sep 3, 2019 Accepting new patients
DLP Person Urgent Care LLC CurrentSince Mar 19, 2025 Accepting new patients
DLP Person Urgent Care LLC CurrentSince Mar 19, 2025 Accepting new patients
Gateway Community Health Centers, Inc CurrentSince Jun 16, 2025 Accepting new patients
Fastmed P.C. CurrentSince Sep 8, 2025 Accepting new patients
Mill Hill Medical Consultants Inc CurrentSince Sep 3, 2019 Accepting new patients
Community Health Center Inc CurrentSince May 1, 2024 Accepting new patients
Fastmed Primary Care, P.C. Past Accepting new patients
Cornell Scott Hill Health Corporation Past Accepting new patients

Locations

19 Grand St
Middletown, CT 06457
Phone (860) 323-0172

365 Montauk Ave
New London, CT 06320
Phone (860) 271-4364

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

7010 NC Highway 751
Durham, NC 27707
Phone (919) 313-3900

1134 N Road St
Elizabeth Cty, NC 27909
Phone (252) 333-1047

3762 Durham Rd
Ste A
Roxboro, NC 27573
Phone (336) 330-0400

Interoperability endpoints

  • Direct secure messaging: keren.john.1@20247.direct.athenahealth.com
  • Direct secure messaging: kerenm.paul@xdr.hhchealthdirect.org

Organizations & group practices 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1550016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755216000000",
    "number": "1285190462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "COMMUNITY HEALTH CENTER",
            "address_2": "675 MAIN STREET",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "06457",
            "telephone_number": "516-510-4160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 MONTAUK AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204700",
            "telephone_number": "860-442-0711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHN",
        "first_name": "KEREN",
        "middle_name": "MARIAM",
        "credential": "PA- CERTIFIED",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-13",
        "last_updated": "2025-08-15",
        "certification_date": "2025-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "4523",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-14522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEREN",
            "last_name": "PAUL",
            "middle_name": "MARIAM",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in New London, CT

Sources for this page

Verify at the official NPI Registry.