Individual provider Active NPI

Holly B. Damiano, N.P.

  • Nurse Practitioner
  • Southborough, MA
National Provider Identifier
1508882747
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
224993 Issued in MA
Practice address
24 Newton St
Southborough, MA 01772-1215
Phone
(508) 460-3250
Fax
(508) 460-3223
NPI assigned
Jul 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 224993 MA Primary

Addresses

Primary practice location

24 Newton St
Southborough, MA 01772-1215

Mailing address

24 Newton St
Southborough, MA 01772-1215
Phone (508) 460-3250

Other identifiers 1

IdentifierTypeStateIssuer
0321940MedicaidMA

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
I20050923000938 MA Practitioner - Nurse Practitioner 7012941438 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Reliant Medical Group IncGroup PAC ID 5597755322, 638 clinicians

Practice addresses (Care Compare)

24 Newton St
Southborough, MA 01772-1215
Phone (508) 486-4472

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
224993MAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Reliant Medical Group, Inc CurrentSince Jan 1, 2015 Accepting new patients

Locations

24 Newton St
Southborough, MA 01772
Phone (508) 460-3190

630 Plantation St
Fl 12
Worcester, MA 01605
Phone (508) 368-5529

5 Neponset St
Worcester, MA 01606
Phone (508) 595-2300

Interoperability endpoints

  • Direct secure messaging: holly.damiano.npi1508882747.reliant@direct.optumcare.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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508882747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 NEWTON ST",
            "city": "SOUTHBOROUGH",
            "state": "MA",
            "postal_code": "017721215",
            "telephone_number": "508-460-3250",
            "fax_number": "508-460-3223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 NEWTON ST",
            "city": "SOUTHBOROUGH",
            "state": "MA",
            "postal_code": "017721215",
            "telephone_number": "508-460-3250",
            "fax_number": "508-460-3223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAMIANO",
        "first_name": "HOLLY",
        "middle_name": "B.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "224993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0321940",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southborough, MA

Sources for this page

Verify at the official NPI Registry.