Individual provider Active NPI

Katlyn Jean Noonan, NP

  • Family Nurse Practitioner
  • Middleton, MA
National Provider Identifier
1457974925
Registry record updated Nov 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN2317025 Issued in MA
Practice address
147 S Main St
Middleton, MA 01949-2446
Phone
(978) 774-2555
NPI assigned
May 19, 2020
Last updated
Nov 2, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN2317025 MA Primary
Registered Nurse 163W00000X RN2317025 MA

Addresses

Primary practice location

147 S Main St
Middleton, MA 01949-2446

Mailing address

147 S Main St
Middleton, MA 01949-2446
Phone (978) 774-2555

Other practice location 1

135 Lewis Rd
Belmont, MA 02478-3830
Phone (617) 595-7440

Other identifiers 1

IdentifierTypeStateIssuer
01949OtherN/A

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Athena

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
I20230228001639 MA Practitioner - Nurse Practitioner 0941673651 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medical Care of Boston Management CorporationGroup PAC ID 6800787714, 293 clinicians

Practice addresses (Care Compare)

32 S Main St
Randolph, MA 02368-4835

501 John Mahar Hwy
Braintree, MA 02184-6562
Phone (781) 356-4900

93 Pond St
Sharon, MA 02067-2015
Phone (781) 784-9212

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN2317025MAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Care of Boston Management Corporation CurrentSince Nov 1, 2024 Accepting new patients

Locations

93 Pond St
Sharon, MA 02067
Phone (781) 784-9212

Interoperability endpoints

  • Direct secure messaging: knoonan164923@direct.bilh.masshiway.net

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

Hospital & facility affiliations 1

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": "1589846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667347200000",
    "number": "1457974925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 S MAIN ST",
            "city": "MIDDLETON",
            "state": "MA",
            "postal_code": "019492446",
            "telephone_number": "978-774-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 S MAIN ST",
            "city": "MIDDLETON",
            "state": "MA",
            "postal_code": "019492446",
            "telephone_number": "978-774-2555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "135 Lewis Rd",
            "address_purpose": "LOCATION",
            "city": "Belmont",
            "state": "MA",
            "postal_code": "024783830",
            "country_code": "US",
            "telephone_number": "617-595-7440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOONAN",
        "first_name": "KATLYN",
        "middle_name": "JEAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-19",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN2317025",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MA",
            "license": "RN2317025",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N/A",
            "identifier": "01949",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Athena",
            "affiliation": "N",
            "address_1": "147 S Main St",
            "city": "Middleton",
            "state": "MA",
            "country_code": "US",
            "postal_code": "019492446",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Middleton, MA

Sources for this page

Verify at the official NPI Registry.