Individual provider Active NPI

Enith Mendez-Runge, PA

  • Medical Physician Assistant
  • Worcester, MA
National Provider Identifier
1386617439
Registry record updated Jul 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1841 Issued in MA
Practice address
189 May Street
Worcester, MA 01602
Phone
(508) 791-6351
Fax
(508) 753-2087
NPI assigned
Feb 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 1841 MA Primary

Addresses

Primary practice location

189 May Street
Worcester, MA 01602

Mailing address

PO Box 391
Wilbraham, MA 01095-0391
Phone (508) 595-0531

Other names 1

  • Enith Mendez Professional 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
I20041119000917 MA Practitioner - Physician Assistant 6608831540 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Inpatient Medical Associates IncGroup PAC ID 7416846977, 59 clinicians

Practice addresses (Care Compare)

233 Carew St
Suite 101
Springfield, MA 01104-2377
Phone (413) 748-9212

271 Carew St
Springfield, MA 01104-2377
Phone (413) 748-9321

Hospital & facility affiliations

  • Mercy Medical Ctr Hospital, Springfield, MA, CCN 220066

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1841MAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Riverbend Medical Group, Inc CurrentSince May 10, 2021 Accepting new patients

Locations

233 Carew St
#101
Springfield, MA 01104
Phone (413) 748-9212

271 Carew St
Springfield, MA 01104
Phone (413) 748-9000

Organizations & group practices 6

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": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469750400000",
    "number": "1386617439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 391",
            "city": "WILBRAHAM",
            "state": "MA",
            "postal_code": "010950391",
            "telephone_number": "508-595-0531",
            "fax_number": "508-829-5367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 MAY STREET",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "01602",
            "telephone_number": "508-791-6351",
            "fax_number": "508-753-2087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDEZ-RUNGE",
        "first_name": "ENITH",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-09",
        "last_updated": "2016-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "1841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ENITH",
            "last_name": "MENDEZ",
            "credential": "PA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.