Individual provider Active NPI

Virginia Haddad, FNP-BC

  • Family Nurse Practitioner
  • Worcester, MA
National Provider Identifier
1902145287
Registry record updated Dec 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN279197 Issued in MA
Practice address
10 Crillon Rd
Worcester, MA 01605-2308
Phone
(774) 641-5565
NPI assigned
Feb 6, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN279197 MA Primary

Addresses

Primary practice location

10 Crillon Rd
Worcester, MA 01605-2308

Mailing address

10 Crillon Rd
Worcester, MA 01605-2308
Phone (774) 641-5565

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130329000170 MA Practitioner - Nurse Practitioner 9537304225 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New Hyperbaric Oxygen Treatment Centers LLCGroup PAC ID 6800070640, 3 clinicians

Practice addresses (Care Compare)

1395 N Main St
Suite G
Randolph, MA 02368-1768
Phone (781) 961-7887

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN279197MAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
New Hyperbaric Oxygen Treatment Centers LLC CurrentSince Oct 1, 2024 Accepting new patients
Steward Medical Group, Inc CurrentSince Mar 1, 2020 Accepting new patients
Lianne Inc CurrentSince Jun 1, 2017 Accepting new patients
Steward Medical Group, Inc CurrentSince Mar 1, 2020 Accepting new patients

Locations

11 Nevins St
Ste 201
Brighton, MA 02135
Phone (617) 789-2442

100 Amesbury St
Ste 103
Lawrence, MA 01840
Phone (978) 683-0157

1395 N Main St
Ste G
Randolph, MA 02368
Phone (781) 961-7887

95 Lincoln St
Worcester, MA 01605
Phone (508) 453-3053

107 Lincoln St
Worcester, MA 01605
Phone (508) 453-3028

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": "1360108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701734400000",
    "number": "1902145287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 CRILLON RD",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052308",
            "telephone_number": "774-641-5565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 CRILLON RD",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052308",
            "telephone_number": "774-641-5565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADDAD",
        "first_name": "VIRGINIA",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-06",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN279197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.