Active NPI
Jonathan F. Ketchum, D.P.M.
- Primary Podiatric Medicine Podiatrist
- Worcester, MA
National Provider Identifier
1922195627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Podiatric Medicine Podiatrist
- License
- 2087
- Practice address
- 488 Pleasant St
Worcester, MA 01609-1857 - Phone
- (508) 755-9573
- NPI assigned
- Oct 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Podiatric Medicine Podiatrist | 213EP1101X | 2087 | MA | Primary |
Addresses
Primary practice location
488 Pleasant St
Worcester, MA 01609-1857
Mailing address
126 Bushy LN
Rutland, MA 01543-2025
Phone (508) 886-6280
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Y71045 | Other | MA | BLUE SHIELD OF MA |
| 333402 | Other | MA | HARVARD PILGRIM HEALTH |
| 0019046 | Other | MA | NEIGHBORHOOD HEALTH |
| 002087 | Other | MA | TUFTS HEALTH PLAN |
| 0316644 | Medicaid | MA | |
| 2700355 | Other | MA | UNITED HEALTHCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2087 | MA | MD | Renal Nutrition Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206403200000",
"number": "1922195627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "126 BUSHY LN",
"city": "RUTLAND",
"state": "MA",
"postal_code": "015432025",
"telephone_number": "508-886-6280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "488 PLEASANT ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016091857",
"telephone_number": "508-755-9573"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETCHUM",
"first_name": "JONATHAN",
"middle_name": "F.",
"credential": "D.P.M.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-06",
"last_updated": "2008-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "213EP1101X",
"taxonomy_group": "",
"desc": "Podiatrist, Primary Podiatric Medicine",
"state": "MA",
"license": "2087",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF MA",
"identifier": "Y71045",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM HEALTH",
"identifier": "333402",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEIGHBORHOOD HEALTH",
"identifier": "0019046",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "002087",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0316644",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "2700355",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.