Individual provider Active NPI

Regina Kelly, LICSW

  • Clinical Social Worker
  • Somerville, MA
National Provider Identifier
1669543054
Registry record updated Nov 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
104581 Issued in MA
Practice address
26 Central St
Somerville, MA 02143-2827
Phone
(617) 591-6408
NPI assigned
Nov 10, 2006
Last updated
Nov 11, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 104581 MA Primary

Addresses

Primary practice location

26 Central St
Somerville, MA 02143-2827

Mailing address

1493 Cambridge Street
Macht B10
Cambridge, MA 02139-1047
Phone (617) 665-1616

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120323000605 MA Practitioner - Clinical Social Worker 2466612791 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1493 Cambridge St
Cambridge, MA 02139-1047
Phone (617) 665-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.27 of 100Reported as group
Quality
77.51
Promoting interoperability
100
Improvement activities
40
Cost
76.72

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
104581MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Cambridge Public Health Commission CurrentSince Dec 12, 1995 Accepting new patients
Cambridge Public Health Commission Current Accepting new patients
Cambridge Public Health Commission CurrentSince Dec 12, 1995 Accepting new patients

Locations

1493 Cambridge St
Cambridge, MA 02139
Phone (617) 665-1185

1493 Cambridge St
#B10
Cambridge, MA 02139
Phone (617) 665-1616

350 Main St
Ste 31
Malden, MA 02148
Phone (781) 397-6583

26 Central St
Somerville, MA 02143
Phone (617) 591-6033

Organizations & group practices 3

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 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": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447200000000",
    "number": "1669543054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1493 CAMBRIDGE STREET",
            "address_2": "MACHT B10",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021391047",
            "telephone_number": "617-665-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 CENTRAL ST",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021432827",
            "telephone_number": "617-591-6408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "REGINA",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-10",
        "last_updated": "2015-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "104581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerville, MA

Sources for this page

Verify at the official NPI Registry.