Individual provider Active NPI

Kelly A Botsoglou, PA

  • Physician Assistant
  • Newton, MA
National Provider Identifier
1528426095
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA7298 Issued in MA
Practice address
2014 Washington St
Newton, MA 02462-1607
Phone
(617) 243-6000
NPI assigned
Jan 29, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA7298 MA Primary

Addresses

Primary practice location

2014 Washington St
Newton, MA 02462-1607

Mailing address

PO Box 415348
Boston, MA 02241-5348
Phone (800) 225-8885

Other practice location 1

119 Belmont St
Worcester, MA 01605-2903
Phone (774) 443-7552

Other practice location 2

55 Lake Ave N
Worcester, MA 01655-0002
Phone (774) 443-7552

Other practice location 3

75 Francis St
Boston, MA 02115-6110
Phone (716) 859-6000

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
I20200518002392 MA Practitioner - Physician Assistant 2466744024 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Umass Memorial Medical Group IncGroup PAC ID 4284539891, 2,494 clinicians

Practice addresses (Care Compare)

1153 Centre St
Jamaica Plain, MA 02130-3446
Phone (617) 983-7000

119 Belmont St
Worcester, MA 01605-2903
Phone (508) 334-1000

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
019458NYMDOccupational Therapist
PA7298MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Umass Memorial Medical Group, Inc. CurrentSince Sep 6, 2022 Accepting new patients
Massachusetts General Physicians Organization Inc CurrentSince Sep 12, 2024 Accepting new patients
General Hospital Corp Current Accepting new patients

Locations

75 Francis St
Boston, MA 02115

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

119 Belmont St
Worcester, MA 01605
Phone (508) 334-6345

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

Interoperability endpoints

  • Direct secure messaging: botsoglou.kelly.mgh@direct.partners.masshiway.net

Organizations & group practices 6

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 5

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": "1454025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1528426095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348",
            "telephone_number": "800-225-8885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2014 WASHINGTON ST",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024621607",
            "telephone_number": "617-243-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "119 Belmont St",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016052903",
            "country_code": "US",
            "telephone_number": "774-443-7552",
            "fax_number": "774-441-6086",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "55 Lake Ave N",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016550002",
            "country_code": "US",
            "telephone_number": "774-443-7552",
            "fax_number": "774-441-6086",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "75 FRANCIS ST",
            "address_purpose": "LOCATION",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156110",
            "country_code": "US",
            "telephone_number": "716-859-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOTSOGLOU",
        "first_name": "KELLY",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-29",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA7298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newton, MA

Sources for this page

Verify at the official NPI Registry.