Individual provider Active NPI

Kiet T. Le, PA

  • Physician Assistant
  • Waltham, MA
National Provider Identifier
1992190748
Registry record updated Feb 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA5572 Issued in MA
Practice address
840 Winter St
Waltham, MA 02451-1433
Phone
(781) 890-2133
Fax
(781) 890-2177
NPI assigned
Mar 30, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA5572 MA Primary

Addresses

Primary practice location

840 Winter St
Waltham, MA 02451-1433

Mailing address

840 Winter St
Attn: Boston Sports & Shoulder Center
Waltham, MA 02451-1650
Phone (781) 890-2133

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
I20160708001510 MA Practitioner - Physician Assistant 0749597763 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northeast Orthopaedic Alliance PLLCGroup PAC ID 5991149809, 288 clinicians

Practice addresses (Care Compare)

125 Parker Hill Ave
Boston, MA 02120-2847
Phone (617) 264-1100

150 Flanders Rd
Westborough, MA 01581-1017
Phone (781) 890-2133

40 Allied Dr
Suite 110
Dedham, MA 02026-6146
Phone (617) 264-1100

Hospital & facility affiliations

  • New England Baptist Hospital Hospital, Boston, MA, CCN 220088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA5572MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Orthopaedic Alliance PLLC CurrentSince Mar 1, 2024 Accepting new patients
Boston Sports & Shoulder Center, LLC CurrentSince Feb 1, 2020 Accepting new patients
Boston Sports & Shoulder Center, LLC CurrentSince Feb 1, 2020 Accepting new patients

Locations

830 Boylston St
Ste 107
Chestnut Hill, MA 02467
Phone (617) 264-1100

40 Allied Dr
Ste 110
Dedham, MA 02026
Phone (617) 264-1100

40 Allied Dr
Dedham, MA 02026
Phone (617) 264-1100

125 Parker Hill Ave
Roxbury Xing, MA 02120
Phone (617) 264-1100

840 Winter St
Waltham, MA 02451
Phone (781) 487-9944

71 Border Rd
Ste 300
Waltham, MA 02451
Phone (781) 890-2133

150 Flanders Rd
Westborough, MA 01581
Phone (508) 870-2222

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/749/brand/1/csg/1/fhir/r4
  • Direct secure messaging: kiet.le.2@749.direct.athenahealth.com

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.

Hospital & facility affiliations 1

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": "1427673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738800000000",
    "number": "1992190748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 WINTER ST",
            "address_2": "ATTN: BOSTON SPORTS & SHOULDER CENTER",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511650",
            "telephone_number": "781-890-2133",
            "fax_number": "781-890-2177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 WINTER ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511433",
            "telephone_number": "781-890-2133",
            "fax_number": "781-890-2177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE",
        "first_name": "KIET",
        "middle_name": "T.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-30",
        "last_updated": "2025-02-06",
        "certification_date": "2025-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA5572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

Verify at the official NPI Registry.