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Deactivated NPI 1093776437 Deactivated / Inactive NPI Male Practitioner

Stephen R Kallock , PHYSICIAN ASSISTANT

Physician Assistant • Jamaica Plain, MA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Stephen Kallock has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date March 28, 2006
NPI Deactivation Date December 06, 2023
Total Practice Duration ~17 Years of Practice (2006 – 2023)

Professional Overview & Biography Verified Profile Summary

Stephen Kallock, PHYSICIAN ASSISTANT was a registered Physician Assistant practicing in Jamaica Plain, MA. Throughout an active medical career spanning 17 years, Stephen Kallock provided care at the practice location at 150 S HUNTINGTON AVE until profile deactivation on 2023-12-06.

Practice Location & Contact Primary Location

Practice Address

150 S Huntington Ave

Jamaica Plain, MA 021304817

Telephone 8573642353
Associated Practice Facility / Clinic
🏢 Boston Cboc Facility NPI 1366495558

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Jamaica Plain, MA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 11.9 Yrs
State Avg: 10.0 Yrs
Regional Practice Density
25 Specialists

Practicing in Jamaica Plain, MA (4746 Statewide)

Telehealth Adoption Rate
16.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License MA 227

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners
Emily Peloquin-Pape , NP

Nurse Practitioner

NPI 1497972517

Nurse Practitioner

Corinne Sheridan , NP

Nurse Practitioner - Occupational Health

NPI 1578656971

Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated December 06, 2023

Record deactivated on December 06, 2023

NPI Profile Active June 18, 2015

NPI status registered as active in NPPES database

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Updated Practice Location June 18, 2015

Registered at 150 S HUNTINGTON AVE, JAMAICA PLAIN, MA 021304817 (Tel: 8573642353)

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Updated Business Mailing Address June 18, 2015

Registered at 35 FERNVIEW AVE, NORTH ANDOVER, MA 018454466 (Tel: 9789790771)

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Provider Name / Credentials Updated June 18, 2015

Recorded as STEPHEN KALLOCK, PHYSICIAN ASSISTANT

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Medical Taxonomy / Specialty Registered (Primary Specialty) June 18, 2015

Physician Assistant (License #227 in MA)

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Initial NPI Registration & Enumeration March 28, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1093776437
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 28, 2006
Last Update: June 18, 2015
Deactivation Date: December 06, 2023

Mailing Address

35 Fernview Ave

North Andover, MA 018454466

Phone: 9789790771

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.