Individual provider Active NPI

Carolyn Nicole Marcello, DPT

  • Physical Therapist
  • Acton, MA
National Provider Identifier
1902443989
Registry record updated Jun 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
26500 Issued in MA
Practice address
340 Great Rd
Acton, MA 01720-4020
Phone
(978) 287-6170
NPI assigned
Dec 9, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 26500 MA Primary

Addresses

Primary practice location

340 Great Rd
Acton, MA 01720-4020

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221130000661 MA Practitioner - Physical Therapist in Private Practice 5991132573 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Performance Rehabilitation of Western New England LLCGroup PAC ID 7911979950, 201 clinicians

Practice addresses (Care Compare)

340 Great Rd
Acton, MA 01720-4020
Phone (978) 287-6170

Merit-based Incentive Payment System (MIPS)

Final score
85.19 of 100Reported as group
Quality
86.04
Improvement activities
40
Cost
76.23

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
26500MAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Performance Rehabilitation of Western New England LLC Physical Therapist CurrentSince Oct 24, 2022 Accepting new patients
Performance Rehabilitation of Western New England LLC Physical Therapist CurrentSince Oct 24, 2022 Accepting new patients
Carl Gustafson LLC Physical Therapist Past Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

33377 Collection Ctr Dr
Chicago, IL 60693
Phone (617) 284-9418

340 Great Rd
Acton, MA 01720
Phone (978) 287-6170

101 University Dr
Ste A6
Amherst, MA 01002
Phone (413) 336-5703

Organizations & group practices 3

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": "1575849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1902443989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 GREAT RD",
            "city": "ACTON",
            "state": "MA",
            "postal_code": "017204020",
            "telephone_number": "978-287-6170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARCELLO",
        "first_name": "CAROLYN",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-09",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "26500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Acton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; 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.