Active NPI
Mary Connolly, PA
- Physician Assistant
- West Roxbury, MA
National Provider Identifier
1306937156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 36
- Practice address
- 15 Berwick St
West Roxbury, MA 02132-4217 - Phone
- (617) 477-3546
- Fax
- (617) 971-3783
- NPI assigned
- Sep 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 36 | MA | Primary |
Addresses
Primary practice location
15 Berwick St
West Roxbury, MA 02132-4217
Mailing address
170 Morton St
Jamaica Plain, MA 02130-3735
Phone (617) 522-8110
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: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170613002902 | MA | Order and Referring Only - Physician Assistant | 3476821554 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36 | MA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1495497600000",
"number": "1306937156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "170 MORTON ST",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021303735",
"telephone_number": "617-522-8110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 BERWICK ST",
"city": "WEST ROXBURY",
"state": "MA",
"postal_code": "021324217",
"telephone_number": "617-477-3546",
"fax_number": "617-971-3783"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOLLY",
"first_name": "MARY",
"name_prefix": "Ms.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-27",
"last_updated": "2017-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MA",
"license": "36",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Roxbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.