Katherine Blake Andersen
Individual provider Active NPI Physician Assistant · Boston, MA
NPI 1760001549 · NPPES record last updated Mar 8, 2023
Key facts
- NPI
- 1760001549
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA7970 (MA)
- Practice address
- 450 Brookline Ave
Boston, MA 02215-5450 - Phone
- (617) 632-3000
- Fax
- (617) 278-6965
- NPI assigned
- Apr 13, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Tufts University School of Medicine, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dana-Farber Cancer Institute, Inc.
Practice addresses (Care Compare)
450 Brookline Ave
Boston, MA 02215-5418
Phone (617) 632-3000
Hospital & facility affiliations
- Dana-Farber Cancer Institute
- Brigham and Women'S Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 84.06 of 100
- Quality
- 65.04
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 69.14
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210504002231 | MA | Practitioner - Physician Assistant | 3274942214 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA7970 | MA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dana-Farber Cancer Institute, Inc. | Current |
Accepting new patients | |
| Dana-Farber Cancer Institute, Inc. | Current |
Accepting new patients |
Locations
450 Brookline Ave
Boston, MA 02215
Phone (508) 478-2061
Interoperability endpoints
- andersen.katherine.dfci@direct.partners.masshiway.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA7970 | MA | Yes |
Addresses
Primary practice location
450 Brookline Ave
Boston, MA 02215-5450
Mailing address
450 Brookline Ave
Boston, MA 02215-5450
Phone (617) 632-3000
NPI Registry JSON
{
"created_epoch": "1586736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678233600000",
"number": "1760001549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 BROOKLINE AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "022155450",
"telephone_number": "617-632-3000",
"fax_number": "617-278-6965"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 BROOKLINE AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "022155450",
"telephone_number": "617-632-3000",
"fax_number": "617-278-6965"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSEN",
"first_name": "KATHERINE",
"middle_name": "BLAKE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-13",
"last_updated": "2023-03-08",
"certification_date": "2023-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MA",
"license": "PA7970",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
- Rachel Marie Ancar
- And Still We Rise, LLC
- Ali Andalib
- Christina Anderlind
- Christian C Andersen
- Kristen Andersen
- Mayer B Andersen
- Michael James Andersen Jr.
- Tayne S Andersen
- Tomas Andersen
All providers in Boston, MA · Physician Assistant in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.