Individual provider Active NPI

Kimberly Mastis, M.D.

  • Psychiatry Physician
  • West Boylston, MA
National Provider Identifier
1285791780
Registry record updated May 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
236381 Issued in MA
Practice address
148 Worcester St
West Boylston, MA 01583-1751
Phone
(508) 835-1735
NPI assigned
Jan 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 236381 MA Primary

Addresses

Primary practice location

148 Worcester St
West Boylston, MA 01583-1751

Mailing address

148 Worcester St
West Boylston, MA 01583-1751

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091209000190 MA Practitioner - Psychiatry 9931248655 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Tufts University School of Medicine, 2004
Medicare assignment
May accept Medicare assignment
Group practices
Pediatric Behavioral Health LLCGroup PAC ID 0042677023, 2 clinicians

Practice addresses (Care Compare)

148 Worcester St
West Boylston, MA 01583-1751
Phone (508) 835-1735

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Behavioral Health, LLC CurrentSince Apr 10, 2023 Accepting new patients
The Carson Center Past Accepting new patients
Carson Center for Human Services, Inc. Past Accepting new patients

Locations

148 Worcester St
West Boylston, MA 01583
Phone (508) 835-1735

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335916800000",
    "number": "1285791780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 WORCESTER ST",
            "city": "WEST BOYLSTON",
            "state": "MA",
            "postal_code": "015831751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 WORCESTER ST",
            "city": "WEST BOYLSTON",
            "state": "MA",
            "postal_code": "015831751",
            "telephone_number": "508-835-1735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASTIS",
        "first_name": "KIMBERLY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-03",
        "last_updated": "2012-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "236381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Boylston, MA

Sources for this page

Verify at the official NPI Registry.