Sudbury Racquet Club Inc.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

SUDBURY RACQUET CLUB INC.

Doing business as

The Longfellow Club

Practice address

524 Boston Post Rd
The Longfellow Club
Wayland, MA 01778-1833

Phone

(508) 358-7355

Fax

(508) 358-3525

NPI assigned

Nov 24, 2006

Last updated

Jun 9, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Jane Polley, M.S., R.D., LDNNPI 1124192505

Title

Dietitian

Phone

(508) 358-7355

Specialties & licenses 2

Addresses

Other identifiers 5

Other names 1

• The Longfellow Club Doing business as

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jane Frances Polley, RD, LDN

  • Registered Dietitian
  • Natick, MA
  • NPI 1124192505

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD Authorized official
• Janna Yamron, M,S,. R.D., L.D.N.

  • Registered Dietitian
  • Wayland, MA
  • NPI 1093901563

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433808000000",
    "number": "1003981903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 BOSTON POST RD",
            "address_2": "THE LONGFELLOW CLUB",
            "city": "WAYLAND",
            "state": "MA",
            "postal_code": "017781833",
            "telephone_number": "508-358-7355",
            "fax_number": "508-358-3525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 BOSTON POST RD",
            "address_2": "THE LONGFELLOW CLUB",
            "city": "WAYLAND",
            "state": "MA",
            "postal_code": "017781833",
            "telephone_number": "508-358-7355",
            "fax_number": "508-358-3525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUDBURY RACQUET CLUB INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-24",
        "last_updated": "2015-06-09",
        "status": "A",
        "authorized_official_last_name": "POLLEY",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "DIETITIAN",
        "authorized_official_telephone_number": "508-358-7355",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "M.S., R.D., LDN"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "763282",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "LG0023",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5582051",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "6300209",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM HEALTH",
            "identifier": "39411",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Longfellow Club",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stacey Koekkoek
• Ciara Staunton
• Greta Gay Stone, LMHC
• Arthur Lee Strafuss
• Laurence James Stybel, ED.D.
• Sudbury River Therapy PLLC
• Robin J Tapper, M.D.
• The Way to Better, Inc.
• Town Center Orthodontics LLC
• Town of Wayland

• Registered Dietitian in Wayland, MA
• Providers in Wayland, MA by specialty
• Registered Dietitian in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.