Breanne Checketts Martin

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA3076 Issued in NV

Practice address

588 Longmeadow St
Longmeadow, MA 01106-2292

Phone

(413) 565-1000

NPI assigned

Jul 5, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Breanne Checketts Former name

Medicare fee-for-service enrollment

Enrolled in NV

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

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1656979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1851024160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "588 LONGMEADOW ST",
            "city": "LONGMEADOW",
            "state": "MA",
            "postal_code": "011062292",
            "telephone_number": "413-535-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "588 LONGMEADOW ST",
            "city": "LONGMEADOW",
            "state": "MA",
            "postal_code": "011062292",
            "telephone_number": "413-565-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "BREANNE",
        "middle_name": "CHECKETTS",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-05",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA3076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BREANNE",
            "last_name": "CHECKETTS",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Deborah Manning, LCSW
• Maple Street Dental PLLC
• Mara M. Veronesi, LLC
• David L. Marinelli, M.D.
• Karen Elizabeth Marsian, DPM
• Linda Martin
• Linda Martin
• Patricia Peters Martin, PH. D.
• Julio A Martinez-Silvestrini, M.D.
• Noemaris Martis

• Physician Assistant in Longmeadow, MA
• Providers in Longmeadow, MA by specialty
• Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.