Active NPI
Cassandra Theodoris, NP
- Acute Care Nurse Practitioner
- Brockton, MA
National Provider Identifier
1316411481
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- RN2312573
- Practice address
- 110 Liberty St
Brockton, MA 02301-5521 - Phone
- (508) 894-0400
- NPI assigned
- Jan 11, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RN2312573 | MA | |
| Acute Care Nurse Practitioner | 363LA2100X | RN2312573 | MA | Primary |
Addresses
Primary practice location
110 Liberty St
Brockton, MA 02301-5521
Mailing address
1440 Eastern Ave
Malden, MA 02148-6112
Other practice location 1
680 Centre St
Brockton, MA 02302-3308
Phone (508) 941-7000
Other names 1
- Cassandra Desjardins
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
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Lahey Clinic Inc
Practice addresses (Care Compare)
29 Mall Rd
Burlington, MA 01805-0001
41 Mall Rd
Burlington, MA 01805-0001
Hospital & facility affiliations
- Lahey Hospital & Medical Center, Burlington
- Winchester Hospital
- Emerson Hospital -
- Northeast Hospital Corporation
Merit-based Incentive Payment System (MIPS)
- Final score
- 91.98 of 100
- Quality
- 76.59
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN2312573 | MA | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lahey Clinic, Inc | Current | Accepting new patients | |
| Lahey Clinic, Inc. | Current | Accepting new patients |
Locations
41 Mall Rd
Burlington, MA 01805
Phone (781) 744-8400
Interoperability endpoints
- ctheodoris87791@direct.bilh.masshiway.net
Organizations & group practices 2
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.
-
- Internal Medicine Physician
- Peabody, MA
- NPI 1063447316
-
- Internal Medicine Physician
- Burlington, MA
- NPI 1538194980
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Concord, MA
- NPI 1922103357
-
- General Acute Care Hospital
- Burlington, MA
- NPI 1558392563
-
- General Acute Care Hospital
- Beverly, MA
- NPI 1316917941
-
- Psychiatric Hospital Unit
- Beverly, MA
- NPI 1407827710
-
- General Acute Care Hospital
- Winchester, MA
- NPI 1790740777
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654128000000",
"number": "1316411481",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1440 EASTERN AVE",
"city": "MALDEN",
"state": "MA",
"postal_code": "021486112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 LIBERTY ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023015521",
"telephone_number": "508-894-0400"
}
],
"practiceLocations": [
{
"address_1": "680 Centre St",
"address_purpose": "LOCATION",
"city": "Brockton",
"state": "MA",
"postal_code": "023023308",
"country_code": "US",
"telephone_number": "508-941-7000",
"fax_number": "508-941-0895",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "THEODORIS",
"first_name": "CASSANDRA",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-01-11",
"last_updated": "2022-06-02",
"certification_date": "2022-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MA",
"license": "RN2312573",
"primary": false
},
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "MA",
"license": "RN2312573",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CASSANDRA",
"last_name": "DESJARDINS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.