JACQUELYN R MCKEAN (NPI# 1356352413) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356352413 |
| Entity Type | Individual |
| Full Name | JACQUELYN R MCKEAN |
| Credential | MD |
| Practice Address |
81 Reservoir Dr Athol MA 01331-4901 |
| Mailing Address |
26 Queen St Medical Worcester MA 01610-2473 |
| Practice Telephone | 9782485135 |
| Mailing Telephone | 5088607700 |
| Mailing Fax Number | 5088607990 |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2020-01-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 206096 | MA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | NHP | 0035749 | 01 |
| MA | 1300709 | 05 | |
| MA | CMSP | 81738 | 01 |
| MA | HARVARD PILGRIM | AA25557 | 01 |
| MA | NETWORK HEALTH | 97679702 | 01 |
| MA | BCBS-GROUP | Y10141 | 01 |
| MA | NHP-GROUP | 0006767 | 01 |
| MA | NETWORK HEALTH-GROUP | 042485308 | 01 |
| MA | FALLON SELECT | 49201 | 01 |
| MA | CIGNA | 2437886 | 01 |
| MA | BCBS | J23197 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 26 Queen St, Medical, Worcester, MA 016102473 | 5088607700 | 5088607990 |
| Street Address |
81 RESERVOIR DR |
| City | ATHOL |
| State | MA |
| Zip Code | 01331-4901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790714079 | Ashley Warner | Family Medicine | 81 Reservoir Dr, Athol, MA 01331 | 2006-06-30 |
| 1962979385 | Marina Konomi | Physician Assistant | 81 Reservoir Dr, Athol, MA 01331-4901 | 2018-10-24 |
| 1952888398 | Amy Elizabeth Deluca | Nurse Practitioner | 81 Reservoir Dr, Athol, MA 01331-4901 | 2018-07-27 |
| 1376081992 | Stephanie Richardson | Nurse Practitioner | 81 Reservoir Dr, Athol, MA 01331-4901 | 2017-02-02 |
| 1689073256 | Erin Koshinsky | Nurse Practitioner | 81 Reservoir Dr, Athol, MA 01331-4901 | 2014-08-19 |
| 1619318359 | Carrie-anne Hale Case | Nurse Practitioner | 81 Reservoir Dr, Athol, MA 01331-4901 | 2013-07-10 |
| 1821228727 | Maireni R Cruz | Internal Medicine | 81 Reservoir Dr, Athol, MA 01331-4901 | 2009-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053811786 | Joyce Ann Dean | Physical Therapy Assistant | 821 Daniel Shays Highway, Athol, MA 01331 | 2018-02-19 |
| 1073049441 | Athol Memorial Hospital Incorporated | Clinic/Center | 81 Reservoir Drive, Athol, MA 01331 | 2017-05-04 |
| 1043680317 | Mark Lorion | Counselor | 491 Main St., Athol, MA 01331 | 2015-09-30 |
| 1184969875 | Vicky Mae Blake | Licensed Practical Nurse | 116 Chase Road, Athol, MA 01331 | 2012-12-06 |
| 1487733358 | Dwight K Stowell Jr Dmd | Dentist | 38 Exchange Street, Athol, MA 01331 | 2006-11-03 |
| 1801981493 | Heidi J Foley | Family Medicine | 78 Brickyard Road, Suite 2, Athol, MA 01331 | 2006-10-03 |
| 1437183266 | Jennifer S Mark | Family Medicine | Athol Memorial Hospital, 2033 Main Street, Athol, MA 01331 | 2006-07-10 |
| 1790732022 | Corazon Yandoc-maramag | Anesthesiology | 298 R Vine Street, Athol, MA 01331 | 2006-05-30 |
| 1336120047 | Athol Memorial Hospital Incorporated | General Acute Care Hospital | 2033 Main Street, Athol, MA 01331 | 2005-11-09 |
| 1801877873 | Fadi Baladi | Internal Medicine | 20 State Road, Phillipston, MA 01331 | 2005-11-08 |
| Find all providers in zip 01331 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801981493 | Heidi J Foley | Family Medicine | 78 Brickyard Road, Suite 2, Athol, MA 01331 | 2006-10-03 |
| 1417965765 | Diane E Grasso | Family Medicine | 201 S Main St Ste 1, Athol, MA 01331-2117 | 2006-08-03 |
| 1437183266 | Jennifer S Mark | Family Medicine | Athol Memorial Hospital, 2033 Main Street, Athol, MA 01331 | 2006-07-10 |
| 1790714079 | Ashley Warner | Family Medicine | 81 Reservoir Dr, Athol, MA 01331 | 2006-06-30 |
| 1740597459 | Olha Duda | Family Medicine | 2033 Main St, Athol, MA 01331-3535 | 2010-09-02 |
| 1861660789 | Cjoseph Mathew Md PC | Family Medicine | 1467 Main St, Suite 1, Athol, MA 01331-2652 | 2008-02-13 |
| 1457302721 | North Quabbin Family Physicians, PC | Family Medicine | 201 S Main St, Athol, MA 01331-2102 | 2006-05-12 |
| 1588664247 | Timothy E Soule-regine | Family Medicine | 201 S Main St, Ste 1, Athol, MA 01331-2117 | 2005-07-26 |
| 1114927878 | Donald E Mruk | Family Medicine | 201 S Main St, Ste 1, Athol, MA 01331-2117 | 2005-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457966806 | Eliana Decastro Cuellar | Family Medicine | 1030 President Ave Ste 1001, Fall River, MA 02720-5923 | 2020-09-12 |
| 1386260594 | Form Health Associates (ma), P.C. | Family Medicine | 179 Lincoln St Ste 404, Boston, MA 02111-2425 | 2020-06-23 |
| 1043835044 | Form Health Associates, P.C. | Family Medicine | 179 Lincoln St Fl 4, Boston, MA 02111-2424 | 2020-06-15 |
| 1588290324 | Lighthouse Primary Care PC | Family Medicine | 315 Main St Ste 101, North Reading, MA 01864-1326 | 2020-03-12 |
| 1730714106 | Berkshire Whole Health PC | Family Medicine | 8 Pine St, Stockbridge, MA 01262-9706 | 2020-03-06 |
| 1578100889 | Kelly Ramappa | Family Medicine | 96 Temple St, West Newton, MA 02465-2307 | 2019-12-05 |
| 1295372787 | Julie A Gil | Family Medicine | 114b Lelandville Rd, Charlton, MA 01507-6714 | 2019-12-04 |
| 1154962942 | Molly Rose Lodigiani | Family Medicine | 275 Cypress St Apt 105, Brookline, MA 02445-6774 | 2019-10-02 |
| 1699316539 | Luisa Alejandra Centeno Silva | Family Medicine | 4785 Washington St # 2, West Roxbury, MA 02132-2113 | 2019-10-02 |
| 1609427962 | Jessica Blanchard | Family Medicine | 100 Leominster Rd, Sterling, MA 01564-2156 | 2019-09-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.