Kelly Ann Diaz, PHYSICIAN ASSISTANT
Individual provider Active NPI Physician Assistant · Charlton, MA
NPI 1568029437 · NPPES record last updated May 24, 2019
Key facts
- NPI
- 1568029437
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 10 N Main St
Charlton, MA 01507-1590 - Phone
- (508) 248-1770
- NPI assigned
- May 24, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190712001930 | MA | Practitioner - Physician Assistant | 2668707654 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5097 | CT | MD | Nurse Practitioner |
Interoperability endpoints
- kelly.diaz@xdr.hhchealthdirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MA | Yes |
Addresses
Primary practice location
10 N Main St
Charlton, MA 01507-1590
Mailing address
1 Denslow Rd
East Longmeadow, MA 01028-3104
Phone (413) 565-1501
Other providers in Charlton, MA
- Cara Ann Davis
- Ruth A Davis
- Kimberly D Delano
- Sara A Destromp
- DG Physical Therapy PC
- Heidi Dileone
- Kelly Dolan
- Danielle Donnelly
- Dustin Downing
- Dr. Carole Duquette, PC
All providers in Charlton, MA · Physician Assistant in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 24, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.