Individual provider Active NPI

Erin Marie Casey

  • Medical Physician Assistant
  • Revere, MA
National Provider Identifier
1568005122
Registry record updated Sep 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
8490 Issued in MA
Practice address
454 Broadway FL 3
Revere, MA 02151-3034
Phone
(781) 485-8222
Fax
(781) 485-8220
NPI assigned
Oct 25, 2019
Last updated
Sep 13, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 13, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 58210 CA
Medical Physician Assistant 363AM0700X 8490 MA Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

454 Broadway FL 3
Revere, MA 02151-3034

Mailing address

454 Broadway FL 3
Revere, MA 02151-3034
Phone (781) 485-8222

Other practice location 1

454 Broadway Fl 3
Revere, MA 02151-3034
Phone (781) 485-8222

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
I20220811001208 MA Practitioner - Physician Assistant 1355758301 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

103 Garland St
Everett, MA 02149-5066
Phone (617) 389-6270

454 Broadway
Revere, MA 02151-3034
Phone (781) 485-8222

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
58210CAMDMarriage & Family Therapist
8490MAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Cambridge Public Health Commission Multi-Specialty CurrentSince Jun 14, 2022 Accepting new patients
Cambridge Public Health Commission Multi-Specialty CurrentSince Jun 14, 2022 Accepting new patients

Locations

1493 Cambridge St
Bldg B13
Cambridge, MA 02139

103 Garland St
Everett, MA 02149
Phone (617) 381-7150

454 Broadway
Fl 3
Revere, MA 02151
Phone (781) 485-8222

Interoperability endpoints

  • Direct secure messaging: ecasey114653@direct.challiance.masshiway.net

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

Hospital & facility affiliations 3

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": "1571961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1568005122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "454 BROADWAY FL 3",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021513034",
            "telephone_number": "781-485-8222",
            "fax_number": "781-485-8220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "454 BROADWAY FL 3",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021513034",
            "telephone_number": "781-485-8222",
            "fax_number": "781-485-8220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "454 Broadway Fl 3",
            "address_purpose": "LOCATION",
            "city": "Revere",
            "state": "MA",
            "postal_code": "021513034",
            "country_code": "US",
            "telephone_number": "781-485-8222",
            "fax_number": "781-485-8220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CASEY",
        "first_name": "ERIN",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-25",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "58210",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "8490",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Revere, MA

Sources for this page

Verify at the official NPI Registry.