Individual provider Active NPI

Judi Rae Carboni

  • Women's Health Nurse Practitioner
  • Salem, NH
National Provider Identifier
1427089226
Registry record updated Mar 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
046941-03 Issued in NH
Practice address
18 Keewaydin Dr
Salem, NH 03079-2839
Phone
(603) 870-9150
NPI assigned
Jul 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 233924 MA
Women's Health Nurse Practitioner 363LW0102X 046941-03 NH Primary

Addresses

Primary practice location

18 Keewaydin Dr
Salem, NH 03079-2839

Mailing address

18 Keewaydin Dr
Salem, NH 03079-2839
Phone (603) 870-9150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NH2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050629000666 MA Practitioner - Nurse Practitioner 0648216788 Reassigns benefits to 2 organizations
I20230531000263 NH Practitioner - Nurse Practitioner 0648216788 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Medical Associates, Inc.Group PAC ID 6002946928, 155 clinicians

Practice addresses (Care Compare)

25 Marston St
Suite 301
Lawrence, MA 01841-2358
Phone (978) 946-8550

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
046941-03NHMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Steward Medical Group, Inc CurrentSince May 31, 2022 Accepting new patients
Steward Medical Group, Inc CurrentSince May 31, 2022 Accepting new patients

Locations

25 Marston St
Ste 301
Lawrence, MA 01841
Phone (978) 946-8230

1 General St
Lawrence, MA 01841
Phone (978) 946-8103

100 Amesbury St
Ste 103
Lawrence, MA 01840
Phone (978) 683-0157

70 East St
Methuen, MA 01844
Phone (978) 682-1906

9 Galen St
Watertown, MA 02472
Phone (617) 562-5413

18 Keewaydin Dr
Salem, NH 03079
Phone (603) 870-9150

22 Keewaydin Dr
Salem, NH 03079
Phone (603) 685-6977

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 4

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": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677801600000",
    "number": "1427089226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 KEEWAYDIN DR",
            "city": "SALEM",
            "state": "NH",
            "postal_code": "030792839",
            "telephone_number": "603-870-9150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 KEEWAYDIN DR",
            "city": "SALEM",
            "state": "NH",
            "postal_code": "030792839",
            "telephone_number": "603-870-9150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARBONI",
        "first_name": "JUDI",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "MA",
            "license": "233924",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NH",
            "license": "046941-03",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, NH

Sources for this page

Verify at the official NPI Registry.