NPIMap

Individual provider Active NPI

Panida Pheang, NP-C

  • Adult Health Nurse Practitioner
  • Ayer, MA
National Provider Identifier
1295447548
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
RN2296859 Issued in MA
Practice address
200 Groton Rd
Ayer, MA 01432-1168
Phone
(978) 784-9328
Fax
(978) 784-9666
NPI assigned
Dec 19, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X RN2296859 MA
Occupational Health Nurse Practitioner 363LX0106X RN2296859 MA
Adult Health Nurse Practitioner 363LA2200X RN2296859 MA Primary

Addresses

Primary practice location

200 Groton Rd
Ayer, MA 01432-1168

Mailing address

200 Groton Rd
Ayer, MA 01432-1168
Phone (978) 784-9328

Other practice location 1

800 Turnpike St Ste 300
North Andover, MA 01845-6156
Phone (978) 494-0441

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240910004133 MA Practitioner - Nurse Practitioner 6204376833 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myhome Healthcare PLLCGroup PAC ID 1254741408, 11 clinicians

Practice addresses (Care Compare)

800 Turnpike St
Suite 300
North Andover, MA 01845-6156
Phone (978) 494-0441

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN2296859MAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Myhome Healthcare, PLLC CurrentSince Sep 9, 2024 Accepting new patients

Locations

800 Turnpike St
Ste 300
North Andover, MA 01845
Phone (978) 494-0441

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22118/brand/1/csg/1/fhir/r4
  • Direct secure messaging: panida.pheang.1@22118.direct.athenahealth.com

Organizations & group practices 1

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 10

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": "1671408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1295447548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 GROTON RD",
            "city": "AYER",
            "state": "MA",
            "postal_code": "014321168",
            "telephone_number": "978-784-9328",
            "fax_number": "978-784-9666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 GROTON RD",
            "city": "AYER",
            "state": "MA",
            "postal_code": "014321168",
            "telephone_number": "978-784-9328",
            "fax_number": "978-784-9666"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Turnpike St Ste 300",
            "address_purpose": "LOCATION",
            "city": "North Andover",
            "state": "MA",
            "postal_code": "018456156",
            "country_code": "US",
            "telephone_number": "978-494-0441",
            "fax_number": "978-288-0198",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHEANG",
        "first_name": "PANIDA",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-19",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MA",
            "license": "RN2296859",
            "primary": false
        },
        {
            "code": "363LX0106X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Occupational Health",
            "state": "MA",
            "license": "RN2296859",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "RN2296859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ayer, MA

Sources for this page

Verify at the official NPI Registry.