Individual provider Active NPI

Kimberly A Marques, P.T.

  • Physical Therapist
  • Worcester, MA
National Provider Identifier
1487943478
Registry record updated Aug 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
15330 Issued in MA
Practice address
120 Gold Star Blvd
Worcester, MA 01606-2825
Phone
(508) 459-5000
Fax
(508) 459-5900
NPI assigned
Mar 31, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 15330 MA Primary

Addresses

Primary practice location

120 Gold Star Blvd
Worcester, MA 01606-2825

Mailing address

280 Boston Tpke
Shrewsbury, MA 01545-2640
Phone (508) 853-4590

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110803000734 MA Practitioner - Physical Therapist in Private Practice 8527237791 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greendale Physical Therapy LLCGroup PAC ID 9133013691, 36 clinicians

Practice addresses (Care Compare)

120 Gold Star Blvd
Worcester, MA 01606-2825
Phone (508) 459-5000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Greendale Physical Therapy, LLC Physical Therapist CurrentSince Apr 1, 2014 Accepting new patients
The Boston Spine Group LLC Physical Therapist PastSince Mar 15, 2010 Accepting new patients
Boston Spine Group, LLC. Past Accepting new patients

Locations

280 Boston Tpke
Shrewsbury, MA 01545
Phone (508) 753-7780

120 Gold Star Blvd
Worcester, MA 01606
Phone (508) 459-5000

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439942400000",
    "number": "1487943478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 BOSTON TPKE",
            "city": "SHREWSBURY",
            "state": "MA",
            "postal_code": "015452640",
            "telephone_number": "508-853-4590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 GOLD STAR BLVD",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062825",
            "telephone_number": "508-459-5000",
            "fax_number": "508-459-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARQUES",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-31",
        "last_updated": "2015-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "15330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.