Individual provider Active NPI

Debra A Litke, RN/NP

  • Adult Health Nurse Practitioner
  • Needham, MA
National Provider Identifier
1578610945
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
212645 Issued in MA
Practice address
941 Great Plain Ave
Needham, MA 02492-3031
Phone
(339) 777-5554
NPI assigned
Jan 5, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 212645 MA Primary

Addresses

Primary practice location

941 Great Plain Ave
Needham, MA 02492-3031

Mailing address

941 Great Plain Ave
Needham, MA 02492-3031
Phone (339) 777-5554

Other practice location 1

138 Conant St
Beverly, MA 01915-1672
Phone (978) 691-5690

Other names 1

  • Debra A Connolly Former name

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
I20081229000161 MA Practitioner - Nurse Practitioner 4789746702 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Dermatology Associates PCGroup PAC ID 3072403799, 84 clinicians

Practice addresses (Care Compare)

138 Conant St
Beverly, MA 01915-1672
Phone (978) 791-2727

Hospital & facility affiliations

  • Northeast Hospital Corporation Hospital, Beverly, MA, CCN 220033

Merit-based Incentive Payment System (MIPS)

Final score
86.63 of 100Reported as group
Quality
84.27
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
212645MAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Neda at North Shore PC CurrentSince Jun 30, 2008 Accepting new patients
Northeast Dermatology Associates, PC CurrentSince Jun 30, 2008 Accepting new patients
Wave Medical Aesthetics Adult Health CurrentSince Oct 6, 2024 Accepting new patients
Nedan LLC Past Accepting new patients

Locations

77 Herrick St
Ste 203
Beverly, MA 01915
Phone (978) 927-4444

138 Conant St
Ste 1
Beverly, MA 01915

138 Conant St
Beverly, MA 01915
Phone (978) 927-5254

22 South St
Hopkinton, MA 01748
Phone (508) 625-0606

941 Great Plain Ave
Needham, MA 02492
Phone (339) 777-5554

538 Turnpike St
North Andover, MA 01845
Phone (978) 683-9201

Interoperability endpoints

  • Direct secure messaging: debra.litke@pd.eclinicaldirectplus.com

Organizations & group practices 4

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": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1578610945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "941 GREAT PLAIN AVE",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024923031",
            "telephone_number": "339-777-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "941 GREAT PLAIN AVE",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024923031",
            "telephone_number": "339-777-5554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "138 Conant St",
            "address_purpose": "LOCATION",
            "city": "Beverly",
            "state": "MA",
            "postal_code": "019151672",
            "country_code": "US",
            "telephone_number": "978-691-5690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LITKE",
        "first_name": "DEBRA",
        "middle_name": "A",
        "credential": "RN/NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "212645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBRA",
            "last_name": "CONNOLLY",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Needham, MA

Sources for this page

Verify at the official NPI Registry.