Individual provider Active NPI

Mericley Santiago, NP

  • Primary Care Nurse Practitioner
  • Fitchburg, MA
National Provider Identifier
1770913410
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
RN282836 Issued in MA
Practice address
881 Main St Unit 304
Fitchburg, MA 01420-9019
Phone
(413) 731-6072
Fax
(508) 425-2550
NPI assigned
Nov 15, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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 RN282836 MA Primary

Addresses

Primary practice location

881 Main St Unit 304
Fitchburg, MA 01420-9019

Mailing address

881 Main St Unit 304
Fitchburg, MA 01420-9019
Phone (413) 731-6072

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
I20140403001448 MA Practitioner - Nurse Practitioner 4284866393

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1384473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1770913410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "881 MAIN ST UNIT 304",
            "city": "FITCHBURG",
            "state": "MA",
            "postal_code": "014209019",
            "telephone_number": "413-731-6072",
            "fax_number": "508-425-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "881 MAIN ST UNIT 304",
            "city": "FITCHBURG",
            "state": "MA",
            "postal_code": "014209019",
            "telephone_number": "413-731-6072",
            "fax_number": "508-425-2550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTIAGO",
        "first_name": "MERICLEY",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-11-15",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MA",
            "license": "RN282836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fitchburg, MA

Sources for this page

Verify at the official NPI Registry.