Individual provider Active NPI

Kathryn M Deanzeris, M.D.

  • Internal Medicine Physician
  • Wellesley, MA
National Provider Identifier
1922056035
Registry record updated Oct 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
223611 Issued in MA
Practice address
40 Walnut St Ste 201
Wellesley, MA 02481-2175
Phone
(781) 235-1224
Fax
(781) 235-4111
NPI assigned
May 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2022

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 223611 MA Primary

Addresses

Primary practice location

40 Walnut St Ste 201
Wellesley, MA 02481-2175

Mailing address

40 Walnut St Ste 201
Wellesley, MA 02481-2175
Phone (781) 235-1224

Other identifiers 1

IdentifierTypeStateIssuer
2113279MedicaidMA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050719000463 MA Practitioner - Internal Medicine 8729015037 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Massachusetts Medical School, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians
Newton Wellesley Primary Care P CGroup PAC ID 2961471255, 8 clinicians

Practice addresses (Care Compare)

2600 Compass Rd
Glenview, IL 60026-8001

40 Walnut St
Suite 201
Wellesley, MA 02481-2102
Phone (781) 235-1224

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
223611MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Newton Wellesley Primary Care P C Internal Medicine CurrentSince Oct 1, 2022 Accepting new patients
Newton Wellesley Ambulatory Services Past Accepting new patients

Locations

40 Walnut St
Ste 201
Wellesley Hills, MA 02481
Phone (781) 235-1224

40 Walnut St
Ste 102
Wellesley Hills, MA 02481
Phone (781) 943-3000

Interoperability endpoints

  • Direct secure messaging: deanzeris.kathryn.nwh@direct.partners.masshiway.net

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.

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": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665705600000",
    "number": "1922056035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 WALNUT ST STE 201",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024812175",
            "telephone_number": "781-235-1224",
            "fax_number": "781-235-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 WALNUT ST STE 201",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024812175",
            "telephone_number": "781-235-1224",
            "fax_number": "781-235-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEANZERIS",
        "first_name": "KATHRYN",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "223611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2113279",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellesley, MA

Sources for this page

Verify at the official NPI Registry.