Individual provider Active NPI

Elizabeth Colman McKeen, MD

  • Pediatrics Physician
  • Peabody, MA
National Provider Identifier
1821257452
Registry record updated Sep 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
L-236075 Issued in MA
Practice address
10 Centennial Drive
Pediatric Health Care Associates
Peabody, MA 01960
Phone
(978) 535-1110
Fax
(978) 535-2907
NPI assigned
Jun 9, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X L-236075 MA Primary

Addresses

Primary practice location

10 Centennial Drive
Pediatric Health Care Associates
Peabody, MA 01960

Mailing address

10 Centennial Dr
Peabody, MA 01960-7938
Phone (978) 535-1110

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110713000084 MA Practitioner - Pediatric Medicine 6002084357 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
L-236075MAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Massachusetts General Physicians Organization Inc Pediatrics CurrentSince Jul 1, 2011 Accepting new patients
The General Hospital Corporation CurrentSince Jul 1, 2011 Accepting new patients
Northeast Hospital Corporation Past Accepting new patients
Pediatric Health Care Associates PC Pediatrics Past Accepting new patients

Locations

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

Interoperability endpoints

  • Direct secure messaging: emckeen6039@direct.chppoc.masshiway.net

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473811200000",
    "number": "1821257452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 CENTENNIAL DR",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019607938",
            "telephone_number": "978-535-1110",
            "fax_number": "978-535-2907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 CENTENNIAL DRIVE",
            "address_2": "PEDIATRIC HEALTH CARE ASSOCIATES",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "01960",
            "telephone_number": "978-535-1110",
            "fax_number": "978-535-2907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKEEN",
        "first_name": "ELIZABETH",
        "middle_name": "COLMAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-09",
        "last_updated": "2016-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "L-236075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peabody, MA

Sources for this page

Verify at the official NPI Registry.