NPIMap

Individual provider Active NPI

Kimberly Ann Parks, DO

  • Cardiovascular Disease Physician
  • Boston, MA
National Provider Identifier
1861686230
Registry record updated Jun 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
236021 Issued in MA
Practice address
55 Fruit St
GB 800
Boston, MA 02114-2621
Phone
(617) 726-2000
NPI assigned
Aug 29, 2007
Last updated
Jun 18, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 25MB07606200 NJ
Cardiovascular Disease Physician 207RC0000X 236021 MA Primary

Addresses

Primary practice location

55 Fruit St
GB 800
Boston, MA 02114-2621

Mailing address

55 Fruit St
GB 800
Boston, MA 02114-2621
Phone (617) 726-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090819000577 MA Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology) 4789646746 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Cardiovascular Disease (Cardiology)
Education
Other, 2001
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Lifestyle Medical and Cardiovascular Associates PCGroup PAC ID 0941611016, 7 clinicians

Practice addresses (Care Compare)

112 Worcester St
Suite 303
Wellesley, MA 02481-3632
Phone (617) 916-9433

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lifestyle Medical and Cardiovascular Associates PC Cardiovascular Disease CurrentSince Dec 1, 2020 Accepting new patients
Mass General Brigham Medical Group Suburban Massachusetts Inc Cardiovascular Disease CurrentSince May 1, 2018 Accepting new patients
Executive Health Resources Clinical Staffing Solutions PC Past Accepting new patients
Clinical Staffing Solutions P.C. Past Accepting new patients
Hera Inpatient Services Past Accepting new patients

Locations

300 Boylston St
Ste 201
Chestnut Hill, MA 02467
Phone (617) 831-7100

2014 Washington St
Newtonville, MA 02462
Phone (617) 243-6000

112 Worcester St
Ste 303
Wellesley Hills, MA 02481
Phone (617) 916-9433

Organizations & group practices 7

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

Hospital & facility affiliations 6

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": "1188345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245283200000",
    "number": "1861686230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "address_2": "GB 800",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-726-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "address_2": "GB 800",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-726-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKS",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-29",
        "last_updated": "2009-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MB07606200",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MA",
            "license": "236021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.