Active NPI
Kerry A Ebert, OTR/L, CHT
- Occupational Therapist
- New York, NY
National Provider Identifier
1649439936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 023629
- Practice address
- 535 E 70TH St
New York, NY 10021-4823 - Phone
- (212) 606-1660
- NPI assigned
- Jun 3, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 023629 | NY | Primary |
| Specialist | 174400000X | 01170 | RI |
Addresses
Primary practice location
535 E 70TH St
New York, NY 10021-4823
Mailing address
PO Box 1119
Providence, RI 02901-1119
Phone (401) 457-1580
Other practice location 1
2 Dudley St
Suite 200
Providence, RI 02905-3236
Phone (401) 457-1580
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01170 | Other | RI | RI LICENSE |
| 09416 | Other | MA | STATE LICENSE - OUT OF STATE |
Electronic endpoints 4
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kebert109575@direct.HSS.edu | Direct | |
| FHIR URL | https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Direct | |
| FHIR URL | https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Direct | |
| FHIR URL | https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/ | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01170 | RI | MD | Specialist |
Interoperability endpoints
- kebert109575@direct.hss.edu
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619049600000",
"number": "1649439936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1119",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029011119",
"telephone_number": "401-457-1580",
"fax_number": "401-831-0500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "535 E 70TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100214823",
"telephone_number": "212-606-1660"
}
],
"practiceLocations": [
{
"address_1": "2 Dudley St",
"address_2": "Suite 200",
"address_purpose": "LOCATION",
"city": "Providence",
"state": "RI",
"postal_code": "029053236",
"country_code": "US",
"telephone_number": "401-457-1580",
"fax_number": "401-831-0500",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "EBERT",
"first_name": "KERRY",
"middle_name": "A",
"credential": "OTR/L, CHT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-03",
"last_updated": "2021-04-22",
"certification_date": "2021-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "023629",
"primary": true
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "RI",
"license": "01170",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RI LICENSE",
"identifier": "01170",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE - OUT OF STATE",
"identifier": "09416",
"state": "MA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kebert109575@direct.HSS.edu",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCDA",
"address_1": "2 Dudley St",
"address_2": "Suite 200",
"city": "Providence",
"state": "RI",
"country_code": "US",
"postal_code": "029053236",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCDA",
"address_1": "535 E 70th St",
"city": "New York",
"state": "NY",
"country_code": "US",
"postal_code": "100214823",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCDA",
"address_1": "535 E 70th St",
"city": "New York",
"state": "NY",
"country_code": "US",
"postal_code": "100214823",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCDA",
"address_1": "535 E 70th St",
"city": "New York",
"state": "NY",
"country_code": "US",
"postal_code": "100214823",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.