Individual provider Active NPI

Kim Graham, NP-C

  • Nurse Practitioner
  • Gloucester, MA
National Provider Identifier
1376764225
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
168831 Issued in MA
Practice address
298 Washington St
Gloucester, MA 01930-4832
Phone
(978) 283-7580
Fax
(978) 283-0456
NPI assigned
May 1, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 168831 MA Primary

Addresses

Primary practice location

298 Washington St
Gloucester, MA 01930-4832

Mailing address

9 Old Jacobs Rd
Georgetown, MA 01833-1009
Phone (978) 352-7540

Other names 1

  • Kim Grennan Former name

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
I20050921000946 MA Practitioner - Nurse Practitioner 0840224689 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

15 Railroad Ave
South Hamilton, MA 01982-2218
Phone (978) 468-7381

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.98 of 100Reported as apm
Quality
76.59
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
168831MAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Beth Israel Lahey Health Specialty Care, Inc. CurrentSince Oct 15, 2000 Accepting new patients
Beth Israel Lahey Health Primary Care, Inc. CurrentSince Mar 6, 2025 Accepting new patients
Beth Israel Lahey Health Primary Care Inc CurrentSince Mar 6, 2025 Accepting new patients

Locations

41 Mall Rd
Burlington, MA 01805
Phone (781) 744-8400

298 Washington St
Gloucester, MA 01930
Phone (978) 283-4000

298 Washington St
Fl 4
Gloucester, MA 01930
Phone (978) 283-2726

302 Washington St
Gloucester, MA 01930
Phone (978) 282-8899

15 Railroad Ave
South Hamilton, MA 01982
Phone (978) 468-7381

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10729/brand/1/csg/1/fhir/r4
  • Direct secure messaging: kgraham33345@direct.bilh.masshiway.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376764225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 OLD JACOBS RD",
            "city": "GEORGETOWN",
            "state": "MA",
            "postal_code": "018331009",
            "telephone_number": "978-352-7540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "298 WASHINGTON ST",
            "city": "GLOUCESTER",
            "state": "MA",
            "postal_code": "019304832",
            "telephone_number": "978-283-7580",
            "fax_number": "978-283-0456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "KIM",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "168831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "GRENNAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Gloucester, MA

Sources for this page

Verify at the official NPI Registry.