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ID OF QUINCY LLC
NPI 1053088377
Dermatology in Quincy, MA

Active since August 25, 2021CLIA 22D2007956 · Certificate of Compliance
104 QUARRY ST STE 2, QUINCY, MA 02169(617) 472-6764(617) 770-9933 Get Directions Write a Review

NPPES record last updated: January 27, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jan 27, 2026, Aug 25, 2021 (2 updates tracked since 2021).

About Id Of Quincy Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ID OF QUINCY LLC (NPI 1053088377) is a healthcare organization registered as a dermatology in Quincy, Massachusetts and active in the NPI registry since August 2021. The organization holds a CLIA Certificate of Compliance certificate valid through May 14, 2028, maintains a secondary practice location in Plymouth, and lists Jennifer T Haley, Authorized Group Official, as its authorized official.

NPPES Registry Identity

NPI1053088377
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameID OF QUINCY LLC
Location Address104 QUARRY ST STE 2Quincy, MA 02169-4174
Mailing Address4700 Exchange Ct Ste 110Boca Raton, FL 33431-4450 · (561) 948-0291
Phone(617) 472-6764
Fax(617) 770-9933
Organization SubpartNo
Authorized OfficialJennifer T HaleyAuthorized Group Official · (561) 314-2000
Enumeration DateAugust 25, 2021
Last NPPES UpdateJanuary 27, 20262 updates tracked since enumeration
NPPES CertifiedJanuary 27, 2026
✔ NPI 1053088377 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
104 QUARRY ST STE 2, Quincy, MA 02169
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Secondary Practice Location 1

Location 140 Industrial Park Rd Ste 202Plymouth, MA 02360-4884 · Phone (617) 472-6764 · Fax (617) 770-9933

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Id Of Quincy Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Id Of Quincy LLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.

Clinicians, nearest first (3)

Kristina Anderson, F.N.P.-C
Nurse Practitioner
NPI 1003299090
104 QUARRY ST STE 2
Quincy, MA 02169
(617) 472-6764
✔ PECOS✔ Accepts MedicareSame address
Christina Correnti, MD, MSCR
Dermatology
NPI 1225457880
104 QUARRY ST STE 2
Quincy, MA 02169
(617) 472-6764
✔ PECOS✔ Accepts MedicareSame address
Kenneth Reed, M.D.
Dermatology
NPI 1295775732
104 QUARRY ST STE 2
Quincy, MA 02169
(617) 472-6764
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 22D2007956

Id Of Quincy · Plymouth, MA
Active · expires May 14, 2028
CLIA Number22D2007956
Laboratory TypePhysician Office
Certificate Effective DateMay 15, 2026
Certificate Expiration DateMay 14, 2028
Laboratory DirectorChristina M. Correnti
Laboratory Phone(508) 747-5559
Laboratory LocationId Of Quincy40 Industrial Park Road, Suite 202, Plymouth, MA 02360
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Id Of Quincy LLC's NPI number?

The NPI number for Id Of Quincy LLC is 1053088377. It was assigned to this organization in the NPPES registry on August 25, 2021.

Where is Id Of Quincy LLC located?

Id Of Quincy LLC is located at 104 Quarry St Ste 2, Quincy, MA 02169. The listed phone number is (617) 472-6764.

What is Id Of Quincy LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Id Of Quincy LLC enrolled in Medicare?

Yes. Id Of Quincy LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Id Of Quincy LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Id Of Quincy LLC, in Dermatology and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Id Of Quincy LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 22D2007956) is associated with this NPI, valid through May 14, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Id Of Quincy LLC was last updated on January 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.