Individual provider Active NPI

Kerunne Ketlogetswe, M.D.

  • Internal Medicine Physician
  • Boston, MA
National Provider Identifier
1619029378
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
228561 Issued in MA
Practice address
75 Francis St
Boston, MA 02115-6110
Phone
(617) 732-5845
NPI assigned
Jan 16, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 228561 MA Primary

Addresses

Primary practice location

75 Francis St
Boston, MA 02115-6110

Mailing address

780 Boylston St
Apt 11F
Boston, MA 02199-7820

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20131014000624 MD Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 6103050828 Reassigns benefits to 2 organizations
I20230824000899 DC Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 6103050828 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Harvard Medical School, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medstar Heart Institute LLCGroup PAC ID 5698932960, 308 clinicians
Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

110 Irving St NW
Washington, DC 20010-3017
Phone (202) 877-2851

1805 Columbia Rd NW
MMG Adams Morgan
Washington, DC 20009-2001
Phone (202) 797-4950

3001 S Hanover St
Baltimore, MD 21225-1233
Phone (410) 350-3200

5601 Lloch Raven Blvd
Baltimore, MD 21239-2945
Phone (410) 933-2424

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.34 of 100Reported as group
Quality
67.9
Promoting interoperability
100
Improvement activities
40
Cost
69.47

Merit-based Incentive Payment System (MIPS)

Final score
85.94 of 100Reported as group
Quality
66.29
Promoting interoperability
100
Improvement activities
40
Cost
74.65

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
228561MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince Mar 7, 2017 Accepting new patients
Medstar Heart Institute LLC CurrentSince Mar 1, 2024 Accepting new patients
Medstar Medical Group II LLC Internal Medicine Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

110 Irving St NW
Washington, DC 20010
Phone (202) 877-2000

1145 19th St NW
Ste 311
Washington, DC 20036
Phone (202) 429-2401

1805 Columbia Rd NW
Washington, DC 20009
Phone (202) 797-4950

3333 N Calvert St
Baltimore, MD 21218
Phone (410) 235-5405

5601 Loch Raven Blvd
Baltimore, MD 21239
Phone (443) 444-4714

3001 S Hanover St
Brooklyn Park, MD 21225
Phone (410) 350-3200

29955 Three Notch Rd
Ste 100
Charlotte Hall, MD 20622
Phone (301) 290-5300

110 Thomas Johnson Dr
Frederick, MD 21702
Phone (202) 877-7685

1406 Crain Hwy S
Ste 106
Glen Burnie, MD 21061
Phone (410) 768-6440

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Medstar Harbor HospitalBaltimore, MD, CCN 210034 Hospital Corporate Director Nov 3, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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

Hospital & facility affiliations 5

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": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619029378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 BOYLSTON ST",
            "address_2": "APT 11F",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021997820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 FRANCIS ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156110",
            "telephone_number": "617-732-5845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETLOGETSWE",
        "first_name": "KERUNNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "228561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.