Individual provider Active NPI

Jaime Daunt Kullak, RN,WHNP

  • Obstetrics & Gynecology Nurse Practitioner
  • Quincy, MA
National Provider Identifier
1508000803
Registry record updated Aug 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
License
RN265781 Issued in MA
Practice address
300 Congress St
102
Quincy, MA 02169-0907
Phone
(617) 479-6636
NPI assigned
Apr 30, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 25, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X RN265781 MA Primary

Addresses

Primary practice location

300 Congress St
102
Quincy, MA 02169-0907

Mailing address

300 Congress St
Suite 102
Quincy, MA 02169-0907
Phone (617) 479-6636

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161205002076 MA Practitioner - Certified Nurse Midwife (CNM) 8921151424 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife, Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Medical Associates CurrentSince Oct 10, 2016 Accepting new patients
Crown Obstetrics and Gynecology PastSince May 25, 2009 Accepting new patients

Locations

55 Fogg Rd
Weymouth, MA 02190
Phone (781) 340-4293

55 Fogg Rd
#85
Weymouth, MA 02190

Organizations & group practices 2

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": "1241049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282694400000",
    "number": "1508000803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CONGRESS ST",
            "address_2": "SUITE 102",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021690907",
            "telephone_number": "617-479-6636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CONGRESS ST",
            "address_2": "102",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021690907",
            "telephone_number": "617-479-6636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULLAK",
        "first_name": "JAIME",
        "middle_name": "DAUNT",
        "name_prefix": "Miss",
        "credential": "RN,WHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-30",
        "last_updated": "2010-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "MA",
            "license": "RN265781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, MA

Sources for this page

Verify at the official NPI Registry.