Jack Krushell, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

74445 Issued in MA

Practice address

40 Holland St
Dermatology Dept.
Somerville, MA 02144-2705

Phone

(617) 629-6250

Fax

(617) 629-6108

NPI assigned

May 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Albany Medical College of Union University, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Atrius Health IncGroup PAC ID 4789588641, 1,214 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Atrius Health, Inc.

  • Internal Medicine Physician
  • Boston, MA
  • NPI 1871639914

  Dermatology

  Medicare reassignment Care Compare group NPD
• Atrius Health, Inc.

  • Internal Medicine Physician
  • Beverly, MA
  • NPI 1114265634
  NPD
• Atrius Health, Inc.

  • Internal Medicine Physician
  • Boston, MA
  • NPI 1740238526

  Dermatology

  NPD (past)

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611532800000",
    "number": "1558328609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 HOLLAND ST",
            "address_2": "DERMATOLOGY DEPT.",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021442705",
            "telephone_number": "617-629-6250",
            "fax_number": "617-629-6108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 HOLLAND ST",
            "address_2": "DERMATOLOGY DEPT.",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021442705",
            "telephone_number": "617-629-6250",
            "fax_number": "617-629-6108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUSHELL",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MA",
            "license": "74445",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3204545",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jkrushellmd3576@direct.atrius.masshiway.net",
            "affiliation": "N",
            "address_1": "40 Holland St",
            "address_2": "Dermatology Dept.",
            "city": "Somerville",
            "state": "MA",
            "country_code": "US",
            "postal_code": "021442705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emma Kross L Kross
• Anya Kroytor, M.A., CCC-SLP
• Geralyn Ashley Kruger, L. AC., MAOM
• Linda Krupp, MSW,LICSW
• Liliana Kruschewsky
• Benjamin A Kruskal, M.D.
• Shaina Kulbersh, MSN, APRN, WHNP-BC
• Andrew M Kulick, D.C.
• Anna Kulmatiski
• Chandra McKenzie Kumar, PT, DPT

• Dermatology Physician in Somerville, MA
• Providers in Somerville, MA by specialty
• Dermatology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.