Individual provider Active NPI

Keziah Catherine Nalukwago

  • Primary Care Nurse Practitioner
  • Salem, MA
National Provider Identifier
1770201915
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
RN2269765 Issued in MA
Practice address
North Shore Community Health
27 Congress Street, Suite 513
Salem, MA 01970
Phone
(978) 825-1175
NPI assigned
Aug 15, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X RN2269765 MA Primary

Addresses

Primary practice location

North Shore Community Health
27 Congress Street, Suite 513
Salem, MA 01970

Mailing address

North Shore Community Health
27 Congress Street, Suite 513
Salem, MA 01970
Phone (978) 825-1175

Other identifiers 1

IdentifierTypeStateIssuer
RN2269765MedicaidMA

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
I20231215000578 MA Practitioner - Nurse Practitioner 5395194328 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore Community Health IncGroup PAC ID 4880666452, 38 clinicians

Practice addresses (Care Compare)

47 Congress St
Salem, MA 01970-7308
Phone (978) 744-8388

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN2269765MAMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Community Health, Inc CurrentSince Sep 26, 2023 Accepting new patients

Locations

89 Foster St
Peabody, MA 01960
Phone (978) 532-4903

27 Congress St
Ste 513
Salem, MA 01970
Phone (978) 825-1175

47 Congress St
Salem, MA 01970
Phone (978) 744-8388

Interoperability endpoints

  • Direct secure messaging: knalukwago34620@direct.ctc.masshiway.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1660521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1770201915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "NORTH SHORE COMMUNITY HEALTH",
            "address_2": "27 CONGRESS STREET, SUITE 513",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "01970",
            "telephone_number": "978-825-1175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NORTH SHORE COMMUNITY HEALTH",
            "address_2": "27 CONGRESS STREET, SUITE 513",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "01970",
            "telephone_number": "978-825-1175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NALUKWAGO",
        "first_name": "KEZIAH",
        "middle_name": "CATHERINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-15",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MA",
            "license": "RN2269765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RN2269765",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, MA

Sources for this page

Verify at the official NPI Registry.