Individual provider Active NPI

Kelly E. Hennessy, NP

  • Family Nurse Practitioner
  • East Boston, MA
National Provider Identifier
1629446307
Registry record updated Sep 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN2280075 Issued in MA
Practice address
10 Gove St
East Boston, MA 02128-1920
Phone
(617) 569-5800
Fax
(617) 568-4780
NPI assigned
Sep 11, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN2280075 MA Primary

Addresses

Primary practice location

10 Gove St
East Boston, MA 02128-1920

Mailing address

10 Gove St
East Boston, MA 02128-1920
Phone (617) 569-5800

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
I20151214000957 MA Practitioner - Nurse Practitioner 8820399066 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Internal Medical Associates-EbnhcGroup PAC ID 6103814371, 239 clinicians

Practice addresses (Care Compare)

10 Gove St
East Boston, MA 02128-1920
Phone (617) 569-5800

Hospital & facility affiliations

  • Boston Medical Center Hospital, Boston, MA, CCN 220031

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Neighborhealth Corporation CurrentSince Nov 5, 2015 Accepting new patients
Internal Medical Associates-Ebnhc CurrentSince Nov 5, 2015 Accepting new patients
Medical Associates of Ebnhc Current Accepting new patients
Neighborhealth Corporation Past Accepting new patients

Locations

10 Grove St
East Boston, MA 02128
Phone (617) 569-5800

Interoperability endpoints

  • Direct secure messaging: khennessy4603@direct.neighborhealth.masshiway.net

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 8

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": "1441929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441929600000",
    "number": "1629446307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 GOVE ST",
            "city": "EAST BOSTON",
            "state": "MA",
            "postal_code": "021281920",
            "telephone_number": "617-569-5800",
            "fax_number": "617-568-4780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 GOVE ST",
            "city": "EAST BOSTON",
            "state": "MA",
            "postal_code": "021281920",
            "telephone_number": "617-569-5800",
            "fax_number": "617-568-4780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNESSY",
        "first_name": "KELLY",
        "middle_name": "E.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-11",
        "last_updated": "2015-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN2280075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Boston, MA

Sources for this page

Verify at the official NPI Registry.