Ida Kellison, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

9512 Issued in MA

Practice address

150 S Huntington Ave
VA Boston Healthcare System, Psychology, 116B
Boston, MA 02130-4817

Phone

(857) 364-6204

NPI assigned

Apr 30, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Newton Neuropsychology GP, PLLC

  • Clinical Psychologist
  • Newton Centre, MA
  • NPI 1487031688
  Medicare reassignment NPD

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

{
    "created_epoch": "1335744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335744000000",
    "number": "1346508140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 S HUNTINGTON AVE",
            "address_2": "VA BOSTON HEALTHCARE SYSTEM, PSYCHOLOGY, 116B",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021304817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 S HUNTINGTON AVE",
            "address_2": "VA BOSTON HEALTHCARE SYSTEM, PSYCHOLOGY, 116B",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021304817",
            "telephone_number": "857-364-6204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLISON",
        "first_name": "IDA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-30",
        "last_updated": "2012-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MA",
            "license": "9512",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "9512",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Kelley, RN
• Danielle Joy Kellier
• Elizabeth A Kelliher, DNP
• Hollie Kelliher
• Amir Bahaa Kellini
• Vickie Marie Kello, RN
• Trenton Tyler Kellock, MD
• Brandon Deshaun Kellum
• Chloe Elyssa Kellum, MD
• Kelly McAdams, Licsw, LLC

• Clinical Neuropsychologist in Boston, MA
• Providers in Boston, MA by specialty
• Clinical Neuropsychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2012; 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.

Verify at the official NPI Registry.