Active NPI
Susan Morrissey, N.P.
- Adult Health Nurse Practitioner
- Boston, MA
National Provider Identifier
1407984636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- RN115188
- Practice address
- 725 Albany St
Shapiro 5, Suite B
Boston, MA 02118-2526 - Phone
- (617) 414-5951
- Fax
- (617) 414-1577
- NPI assigned
- Mar 1, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | RN115188 | MA | Primary |
Addresses
Primary practice location
725 Albany St
Shapiro 5, Suite B
Boston, MA 02118-2526
Mailing address
850 Harrison Ave
Yacc BN-C7
Boston, MA 02118-4001
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110018302A | Medicaid | MA |
Other names 1
- Ms. Susan Kelly
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN115188 | MA | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Evans Medical Foundation, Inc. | Adult Health | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389830400000",
"number": "1407984636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "850 HARRISON AVE",
"address_2": "YACC BN-C7",
"city": "BOSTON",
"state": "MA",
"postal_code": "021184001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 ALBANY ST",
"address_2": "SHAPIRO 5, SUITE B",
"city": "BOSTON",
"state": "MA",
"postal_code": "021182526",
"telephone_number": "617-414-5951",
"fax_number": "617-414-1577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORRISSEY",
"first_name": "SUSAN",
"name_prefix": "Ms.",
"credential": "N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-01",
"last_updated": "2014-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "MA",
"license": "RN115188",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110018302A",
"state": "MA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SUSAN",
"last_name": "KELLY",
"prefix": "MS.",
"credential": "N.P.",
"code": "5",
"type": "Other Name"
}
]
}
Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.