Individual provider Active NPI

Katie Kirleis, AU.D.

  • Audiologist
  • Danvers, MA
National Provider Identifier
1902156078
Registry record updated Aug 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
1031 Issued in MA
Practice address
104 Endicott St
Suite 100
Danvers, MA 01923-3623
Phone
(978) 745-6601
NPI assigned
Sep 14, 2012
Last updated
Aug 12, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 1031 MA Primary

Addresses

Primary practice location

104 Endicott St
Suite 100
Danvers, MA 01923-3623

Mailing address

104 Endicott St
Suite 100
Danvers, MA 01923-3623
Phone (978) 745-6601

Other names 1

  • Katie Connell Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140922001550 MA Practitioner - Qualified Audiologist 9537311246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore Ear, Nose and Throat Associates, PCGroup PAC ID 9032138367, 17 clinicians

Practice addresses (Care Compare)

104 Endicott St
Suite 100
Danvers, MA 01923-0009
Phone (978) 745-6601

104 Endicott St
Suite 100
Danvers, MA 01923-3623

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
01264MDMDSpeech-Language Pathologist
1031MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Ear, Nose & Throat Associates, PC CurrentSince Aug 1, 2014 Accepting new patients
Hearing Professionals, Inc Audiologist Past Accepting new patients

Locations

104 Endicott St
Ste 100
Danvers, MA 01923
Phone (978) 745-6601

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1347580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407801600000",
    "number": "1902156078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 ENDICOTT ST",
            "address_2": "SUITE 100",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019233623",
            "telephone_number": "978-745-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 ENDICOTT ST",
            "address_2": "SUITE 100",
            "city": "DANVERS",
            "state": "MA",
            "postal_code": "019233623",
            "telephone_number": "978-745-6601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRLEIS",
        "first_name": "KATIE",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-14",
        "last_updated": "2014-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MA",
            "license": "1031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "CONNELL",
            "credential": "AU.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Danvers, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.