NPI |
1952052938 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Entity Type Code |
1 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Last Name Legal Name |
CARPENTER |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
KATE |
The first name of the provider, if the provider
is an individual. |
Provider First Line Business Practice Location Address |
137 W BOYLSTON ST |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
WEST BOYLSTON |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MA |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
015831713 |
|
Provider Business Practice Location Address Country Code If outside U S |
US |
|
Provider Business Practice Location Address Telephone Number |
8608353999 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Enumeration Date |
1/12/2022 |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Last Update Date |
1/12/2022 |
|
Provider Gender Code |
F |
|
Healthcare Provider Taxonomy Code 1 |
183500000X |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number 1 |
PH240553 |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Provider License Number State Code 1 |
CT |
|
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Is Sole Proprietor |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
NPI Certification Date |
1/12/2022 |
|