NPIMap

Individual provider Active NPI

Kelly M Wanamaker, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Springfield, MA
National Provider Identifier
1578713939
Registry record updated Nov 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
269101 Issued in MA
Practice address
2 Medical Center Dr Ste 512
Springfield, MA 01107-1273
Phone
(413) 794-5550
Fax
(413) 794-4212
NPI assigned
Sep 23, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 269101 MA Primary

Addresses

Primary practice location

2 Medical Center Dr Ste 512
Springfield, MA 01107-1273

Mailing address

280 Chestnut Street
2ND Floor
Springfield, MA 01199-1001
Phone (413) 794-5700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, MA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170905001703 PA Practitioner - Cardiac SurgeryPractitioner - Thoracic Surgery 4981874302 Reassigns benefits to 2 organizations
I20190604002463 MA Practitioner - Thoracic SurgeryPractitioner - Cardiac Surgery 4981874302 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Thoracic SurgeryAlso: Cardiac Surgery
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baystate Medical Practices IncGroup PAC ID 5991602971, 1,350 clinicians

Practice addresses (Care Compare)

2 Medical Ctr Dr
Suite 512
Springfield, MA 01107-1273
Phone (413) 794-5550

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)36

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Women'S Health Group, LLC CurrentSince May 20, 2019 Accepting new patients
Lehigh Valley Physician Group Surgery Current Accepting new patients
Family Care Centers Inc. Surgery CurrentSince Aug 1, 2017 Accepting new patients
Lehigh Valley Physician Group CurrentSince Jul 17, 2017 Accepting new patients
Baystate Medical Practices, Inc Surgery CurrentSince May 20, 2019 Accepting new patients
Family Care Centers Inc CurrentSince Aug 1, 2017 Accepting new patients
Lehigh Valley Physician Group CurrentSince Jul 17, 2017 Accepting new patients
Baystate Medical Center Inc Past Accepting new patients

Locations

2 Medical Center Dr
Ste 512
Springfield, MA 01107
Phone (413) 732-2311

759 Chestnut St
Springfield, MA 01199
Phone (413) 794-3233

280 Chestnut St
Fl 2
Springfield, MA 01199
Phone (413) 788-4385

1250 S Cedar Crest Blvd
Ste 310
Allentown, PA 18103
Phone (610) 402-6890

2100 Mack Blvd
Fl 2
Allentown, PA 18103

500 Plaza Ct
Ste A
East Stroudsburg, PA 18301
Phone (570) 424-9970

206 E Brown St
East Stroudsburg, PA 18301
Phone (570) 420-4951

500 Plaza Ct
East Stroudsburg, PA 18301
Phone (570) 426-2330

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

Organizations & group practices 9

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 9

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": "1222128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637884800000",
    "number": "1578713939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 CHESTNUT STREET",
            "address_2": "2ND FLOOR",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011991001",
            "telephone_number": "413-794-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MEDICAL CENTER DR STE 512",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011071273",
            "telephone_number": "413-794-5550",
            "fax_number": "413-794-4212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANAMAKER",
        "first_name": "KELLY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-23",
        "last_updated": "2021-11-26",
        "certification_date": "2021-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MA",
            "license": "269101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MA

Sources for this page

Verify at the official NPI Registry.