NPIMap

Organization Active NPI

Worcester Pediatrics PC

  • Pediatrics Physician
  • Worcester, MA
National Provider Identifier
1740654599
Registry record updated Oct 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
WORCESTER PEDIATRICS PC
Practice address
123 Summer St
690 North
Worcester, MA 01608-1216
Phone
(508) 363-9530
Fax
(508) 363-9535
NPI assigned
Nov 17, 2015
Last updated
Oct 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2016

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

Authorized official

Name
Paulette Kimball-Wren, M.D.NPI 1194789644
Title
President
Phone
(508) 363-9530

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

123 Summer St
690 North
Worcester, MA 01608-1216

Mailing address

123 Summer St
690 North
Worcester, MA 01608-1216
Phone (508) 363-9530

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D0069690Worcester Pediatrics, PC123 Summer St, Worcester, MA 01608Certificate of waiverJan 11, 2027

National Provider Directory

National Provider Directory

Locations

123 Summer St
#690N
Worcester, MA 01608
Phone (508) 363-9530

123 Summer St
Ste 690
Worcester, MA 01608
Phone (508) 363-9530

123 Summer St
Ste 690N
Worcester, MA 01608

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475539200000",
    "number": "1740654599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 SUMMER ST",
            "address_2": "690 NORTH",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016081216",
            "telephone_number": "508-363-9530",
            "fax_number": "508-363-9535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 SUMMER ST",
            "address_2": "690 NORTH",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016081216",
            "telephone_number": "508-363-9530",
            "fax_number": "508-363-9535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WORCESTER PEDIATRICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-17",
        "last_updated": "2016-10-04",
        "status": "A",
        "authorized_official_last_name": "KIMBALL-WREN",
        "authorized_official_first_name": "PAULETTE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "508-363-9530",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.