Active NPI
Kenneth W Macdonald
- Peer Specialist
- Brockton, MA
National Provider Identifier
1811765498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 10 Christy Dr
Brockton, MA 02301-1812 - Phone
- (508) 580-8700
- NPI assigned
- Dec 13, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | Primary |
Addresses
Primary practice location
10 Christy Dr
Brockton, MA 02301-1812
Mailing address
114 Hogg Memorial Dr
Whitman, MA 02382-1827
Phone (781) 351-8550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1702425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702425600000",
"number": "1811765498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 HOGG MEMORIAL DR",
"city": "WHITMAN",
"state": "MA",
"postal_code": "023821827",
"telephone_number": "781-351-8550",
"fax_number": "781-447-1786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 CHRISTY DR",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023011812",
"telephone_number": "508-580-8700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACDONALD",
"first_name": "KENNETH",
"middle_name": "W",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-12-13",
"last_updated": "2023-12-13",
"certification_date": "2023-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.