NPIMap

Organization Active NPI

Edward M. Kennedy Community Health Center, Inc

  • Clinic Pharmacy
  • Worcester, MA
National Provider Identifier
1013048347
Registry record updated Nov 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
495 Issued in MA
Legal business name
EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC
Practice address
19 Tacoma St
Worcester, MA 01605-3516
Phone
(508) 854-2128
Fax
(508) 595-1127
NPI assigned
Mar 8, 2007
Organization subpart
Yes
Parent organization
EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 27, 2019

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

Authorized official

Name
Mr. Stephen J Kerrigan
Title
President & Ceo
Phone
(508) 854-2122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 495 MA Primary

Addresses

Primary practice location

19 Tacoma St
Worcester, MA 01605-3516

Mailing address

650 Lincoln St
Worcester, MA 01605-2060
Phone (508) 854-2122

Other identifiers 2

IdentifierTypeStateIssuer
110022061AMedicaidMA
0443891MedicaidMA

Other names 1

  • Great Brook Valley Health Center, Inc Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260601000607 MA Part B Supplier - Pharmacy 3476512740 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Worcester, MA; Milford, MA; Framingham, MA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Edward M Kennedy Community Health Center Inc9 organizations share this tax ID, including this one
Part of
Edward M Kennedy Community Health Center Inc

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

345 Waverley St
Framingham, MA 01702

631 Lincoln St
Worcester, MA 01605
Phone (508) 854-3300

Practitioners & affiliated clinicians

Practitioners 46

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574812800000",
    "number": "1013048347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 LINCOLN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052060",
            "telephone_number": "508-854-2122",
            "fax_number": "508-853-8593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 TACOMA ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016053516",
            "telephone_number": "508-854-2128",
            "fax_number": "508-595-1127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC",
        "enumeration_date": "2007-03-08",
        "last_updated": "2019-11-27",
        "status": "A",
        "authorized_official_last_name": "KERRIGAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "508-854-2122",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "MA",
            "license": "495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110022061A",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0443891",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Brook Valley Health Center, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Great Brook Valley Health Center, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2019; 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.