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KATHRYN EDMISTON M.D.
NPI 1306820790
Internal Medicine - Hematology & Oncology in Worcester, MA

Active since November 30, 2005PECOS EnrolledAccepts Medicare Assignment
97.02/100
CMS Quality Rating
55 LAKE AVE N, WORCESTER, MA 01655(508) 334-6200(774) 442-6715 Get Directions Write a Review

NPPES record last updated: October 30, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kathryn Edmiston M.d. NPPES

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

KATHRYN EDMISTON M.D. (NPI 1306820790) is an individual hematology & oncology provider in Worcester, Massachusetts, licensed in Massachusetts (57722) and active in the NPI registry since November 2005. She is enrolled in Medicare PECOS, is affiliated with Umass Memorial Healthalliance Hospitals, and is a graduate of University Of Chicago, Pritzker School Of Medicine (1982).

NPPES Registry Identity

NPI1306820790
Entity TypeIndividualFemale
Primary Taxonomy207RH0003X
Provider Legal NameKATHRYN EDMISTONCredential: M.D.
Location Address55 LAKE AVE NWorcester, MA 01655-0002
Mailing AddressPo Box 415348Boston, MA 02241-5348
Phone(508) 334-6200
Fax(774) 442-6715
Sole ProprietorNo
Medical School CMSUniversity Of Chicago, Pritzker School Of MedicineGraduated 1982
Enumeration DateNovember 30, 2005
Last NPPES UpdateOctober 30, 2020
NPPES CertifiedOctober 30, 2020
✔ NPI 1306820790 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Hematology & OncologyAllopathic & Osteopathic Physicians
Taxonomy Code207RH0003X
License✔ Licensed in MA · 57722
Definition
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.
55 LAKE AVE N, Worcester, MA 01655
Open in Google Maps ↗

Other Identifiers 1

Medicaid110044291AMA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kathryn Edmiston M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5092890186
PECOS Enrollment IDI20080313000447
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
260 services181 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
159 services71 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
126 services121 patients
New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205
This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
31 services31 patients

Hospital Affiliations CMS Care Compare 5

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Umass Memorial Healthalliance Hospitals

Acute Care Hospitals · Leominster, MA
2/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number220001
Location60 Hospital RoadLeominster, MA 01453 · Worcester County
Emergency services

Umass Memorial Health - Harrington Hospital

Acute Care Hospitals · Southbridge, MA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220019
Location100 South StreetSouthbridge, MA 01550 · Worcester County
Emergency services

Umass Memorial Healthcare-Marlborough Hospital

Acute Care Hospitals · Marlborough, MA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220049
Location157 Union StreetMarlborough, MA 01752 · Middlesex County
Emergency services

Milford Regional Medical Center

Acute Care Hospitals · Milford, MA
4/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number220090
Location14 Prospect StreetMilford, MA 01757 · Worcester County
Emergency services Birthing friendly

Umass Memorial Medical Center/University Campus

Acute Care Hospitals · Worcester, MA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220163
Location55 Lake Avenue NorthWorcester, MA 01655 · Worcester County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 01655 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$177.36 typical visit price
range $58.86 – $177.36
Typical copayment $44.34 (range $14.71 – $44.34)
Most-billed visit code 99205
Established Patient
$103.48 typical visit price
range $19.11 – $144.84
Typical copayment $25.87 (range $4.77 – $36.21)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

97.02/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality78.09
Promoting Interoperability100
Improvement Activities40

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Capecitabine, oral, 500 mg J8521
Treatment-Treatment - Miscellaneous · category RX029N
1 supplier14 claims1,022 services$0.67 avg. paid by Medicare
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type L8000
DME-Orthotic Devices · category DF000N
2 suppliers40 claims116 services$30.08 avg. paid by Medicare
Breast prosthesis, silicone or equal, without integral adhesive L8030
DME-Orthotic Devices · category DF000N
1 supplier23 claims27 services$345.47 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HILLARY R. IRONS MD
Emergency Medicine
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 421-1400
MS. EILEEN A. DUHAMEL NP
Nurse Practitioner
55 LAKE AVE N, DEPARTMENT OF RADIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-2710
EWA HRYNISZYN CRNA
Nurse Anesthetist, Certified Registered
55 LAKE AVE N, DEPARTMENT OF ANESTHESIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-3271
HELEN COPSEY PA-C
Physician Assistant
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-8585
DR. ADEPEJU GBADEBO CHAMPION M.D.
Internal Medicine
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-2731
SOWMYA KORAPATI
Internal Medicine (Hematology & Oncology)
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-3550
LAYLA FAKHRZADEH M.D.
Anesthesiology
55 LAKE AVE N, ANESTHESIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-3271
YOONYIE CHO M.D.
Anesthesiology
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-1000

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 Kathryn Edmiston's NPI number?

The NPI number for Kathryn Edmiston is 1306820790. It was assigned to this individual provider in the NPPES registry on November 30, 2005.

Where is Kathryn Edmiston located?

Kathryn Edmiston practices at 55 Lake Ave N, Worcester, MA 01655. The listed phone number is (508) 334-6200.

What is Kathryn Edmiston's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Hematology & Oncology, with taxonomy code 207RH0003X.

Is Kathryn Edmiston enrolled in Medicare?

Yes. Kathryn Edmiston is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Kathryn Edmiston accept?

Health plans from Anthem Blue Cross and Blue Shield list Kathryn Edmiston as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Kathryn Edmiston affiliated with any hospitals?

According to CMS data, Kathryn Edmiston is affiliated with Umass Memorial Healthalliance Hospitals, Umass Memorial Health - Harrington Hospital, Umass Memorial Healthcare-Marlborough Hospital, Milford Regional Medical Center and Umass Memorial Medical Center/University Campus.

When was this NPI record last updated?

The NPPES record for Kathryn Edmiston was last updated on October 30, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.