NPIMap

Individual provider Active NPI

Robert P Kelleher, MD

  • Internal Medicine Physician
  • Watertown, MA
National Provider Identifier
1891761714
Registry record updated Mar 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
227042 Issued in MA
Practice address
521 Mount Auburn St
Ste 202
Watertown, MA 02472-4191
Phone
(617) 926-9000
Fax
(617) 926-7053
NPI assigned
Feb 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 227042 MA Primary

Addresses

Primary practice location

521 Mount Auburn St
Ste 202
Watertown, MA 02472-4191

Mailing address

521 Mount Auburn St
Ste 202
Watertown, MA 02472-4191
Phone (617) 926-9000

Other identifiers 2

IdentifierTypeStateIssuer
2115620MedicaidMA
J40520OtherMABLUE CROSS

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
I20060418000176 MA Practitioner - Internal Medicine 5193734218 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Georgetown University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mount Auburn Professional Services IncGroup PAC ID 6103725031, 229 clinicians

Practice addresses (Care Compare)

57 Bedford St
Suite 130
Lexington, MA 02420-4543
Phone (781) 862-7500

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Auburn Professional Services Inc Internal Medicine CurrentSince Mar 8, 2006 Accepting new patients
Mt Auburn Professional Services Internal Medicine CurrentSince Mar 8, 2006 Accepting new patients

Locations

57 Bedford St
Ste 130
Lexington, MA 02420
Phone (781) 484-7500

521 Mount Auburn St
Ste 202
Watertown, MA 02472
Phone (617) 926-9000

Interoperability endpoints

  • Direct secure messaging: rkelleher254679@direct.bilh.masshiway.net
  • FHIR API: https://api.platform.athenahealth.com/86/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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.

Hospital & facility affiliations 7

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": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268092800000",
    "number": "1891761714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 MOUNT AUBURN ST",
            "address_2": "STE 202",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024724191",
            "telephone_number": "617-926-9000",
            "fax_number": "617-926-7053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 MOUNT AUBURN ST",
            "address_2": "STE 202",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024724191",
            "telephone_number": "617-926-9000",
            "fax_number": "617-926-7053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEHER",
        "first_name": "ROBERT",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2010-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "227042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2115620",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "J40520",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, MA

Sources for this page

Verify at the official NPI Registry.