Individual provider Active NPI

Raquel Donnelly, PA-C

  • Physician Assistant
  • Concord, MA
National Provider Identifier
1689125536
Registry record updated Oct 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA5752 Issued in MA
Practice address
131 Old Road to 9 Acre Cor
Concord, MA 01742-4181
Phone
(978) 287-3435
NPI assigned
Oct 16, 2016
Last updated
Oct 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA5752 MA Primary

Addresses

Primary practice location

131 Old Road to 9 Acre Cor
Concord, MA 01742-4181

Mailing address

131 Old Road to 9 Acre Cor
Concord, MA 01742-4181
Phone (978) 287-3435

Other practice location 1

300 Longwood Ave
Boston, MA 02115-5724
Phone (508) 246-9600

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
I20180308001516 MA Practitioner - Physician Assistant 0143581132 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Tufts University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

55 Fruit St
Boston, MA 02114-2696
Phone (617) 724-0287

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA5752MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dana-Farber Cancer Institute, Inc. CurrentSince Jan 17, 2018 Accepting new patients
General Hospital Corp Current Accepting new patients
Massachusetts General Physicians Organization Inc CurrentSince Dec 21, 2022 Accepting new patients

Locations

450 Brookline Ave
Boston, MA 02215
Phone (508) 478-2061

450 Brookline Ave
#204
Boston, MA 02215
Phone (617) 632-3252

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

Interoperability endpoints

  • Direct secure messaging: donnelly.raquel.dfci@direct.partners.masshiway.net
  • Direct secure messaging: donnelly.raquel.mgh@direct.partners.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1476576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1689125536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 OLD ROAD TO 9 ACRE COR",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017424181",
            "telephone_number": "978-287-3435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 OLD ROAD TO 9 ACRE COR",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017424181",
            "telephone_number": "978-287-3435"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Longwood Ave",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021155724",
            "country_code": "US",
            "telephone_number": "508-246-9600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "RAQUEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-16",
        "last_updated": "2022-10-20",
        "certification_date": "2022-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA5752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, MA

Sources for this page

Verify at the official NPI Registry.