Individual provider Active NPI

Peninah Elizabeth Waithira

  • Psychiatric/Mental Health Nurse Practitioner
  • Southbridge, MA
National Provider Identifier
1487301768
Registry record updated Mar 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
RN2298837 Issued in MA
Practice address
29 Pine St
Southbridge, MA 01550-1823
Phone
(508) 765-9167
NPI assigned
Mar 7, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN2298837 MA Primary

Addresses

Primary practice location

29 Pine St
Southbridge, MA 01550-1823

Mailing address

PO Box 40
Southbridge, MA 01550-0040

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
I20221006000992 MA Practitioner - Nurse Practitioner 4789060237 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hri Clinics, Inc.Group PAC ID 8022088483, 104 clinicians
Circle Integrative Psychiatric GroupGroup PAC ID 7517314560, 3 clinicians

Practice addresses (Care Compare)

411 Chandler St
Worcester, MA 01602-3339
Phone (508) 799-0688

90 Madison St
Suite 302
Worcester, MA 01608-2072
Phone (508) 713-0297

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN2298837MAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Circle Integrative Psychiatric Group Psychiatric/Mental Health CurrentSince Oct 1, 2023 Accepting new patients
Ysabel Gomez Clinical Services LLC CurrentSince Oct 1, 2023 Accepting new patients
Hri Clinics, Inc. CurrentSince Aug 8, 2022 Accepting new patients
Hri Clinics Inc CurrentSince Aug 8, 2022 Accepting new patients

Locations

14 Fordham Rd
Boston, MA 02134
Phone (617) 783-9676

90 Madison St
Ste 302
Worcester, MA 01608
Phone (508) 713-0297

Organizations & group practices 4

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": "1646611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1487301768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "SOUTHBRIDGE",
            "state": "MA",
            "postal_code": "015500040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 PINE ST",
            "city": "SOUTHBRIDGE",
            "state": "MA",
            "postal_code": "015501823",
            "telephone_number": "508-765-9167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAITHIRA",
        "first_name": "PENINAH",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-07",
        "last_updated": "2022-03-07",
        "certification_date": "2022-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2298837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southbridge, MA

Sources for this page

Verify at the official NPI Registry.