Individual provider Active NPI

Donna Marie Kentley, PA

  • Physician Assistant
  • Southbridge, MA
National Provider Identifier
1356495907
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA5624 Issued in MA
Practice address
55 Sayles St
Southbridge, MA 01550-1729
Phone
(508) 764-2400
Fax
(508) 909-7770
NPI assigned
Jan 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA5624 MA Primary

Addresses

Primary practice location

55 Sayles St
Southbridge, MA 01550-1729

Mailing address

PO Box 415348
Boston, MA 02241-5348
Phone (800) 225-8885

Other identifiers 1

IdentifierTypeStateIssuer
110118960AMedicaidMA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161019001785 MA Practitioner - Physician Assistant 6507812856 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Umass Memorial Medical Group IncGroup PAC ID 4284539891, 2,494 clinicians

Practice addresses (Care Compare)

10 N Main St
Charlton, MA 01507-1590
Phone (508) 248-3015

100 S St
Southbridge, MA 01550-4051
Phone (508) 765-9771

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

55 Sayles St
Southbridge, MA 01550-1729
Phone (508) 764-2400

79 Sayles St
Southbridge, MA 01550-1729
Phone (508) 764-6041

Hospital & facility affiliations

  • Umass Memorial Health - Harrington Hospital Hospital, Southbridge, MA, CCN 220019
  • Umass Memorial Medical Center/University Campus Hospital, Worcester, MA, CCN 220163

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
82.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA5624MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Umass Memorial Medical Group, Inc. CurrentSince Aug 1, 2016 Accepting new patients

Locations

55 Sayles St
Southbridge, MA 01550
Phone (508) 764-2400

100 South St
Southbridge, MA 01550
Phone (508) 764-8012

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

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.

Hospital & facility affiliations 2

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": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1356495907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348",
            "telephone_number": "800-225-8885",
            "fax_number": "508-764-2432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 SAYLES ST",
            "city": "SOUTHBRIDGE",
            "state": "MA",
            "postal_code": "015501729",
            "telephone_number": "508-764-2400",
            "fax_number": "508-909-7770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENTLEY",
        "first_name": "DONNA",
        "middle_name": "MARIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA5624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110118960A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southbridge, MA

Sources for this page

Verify at the official NPI Registry.