Active NPI
Henry R Vaillancourt, MD
- Family Medicine Physician
- Fall River, MA
National Provider Identifier
1093770059
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 42866
- Practice address
- 1030 President Ave
Suite 104 Southcoast Physician Services Inc
Fall River, MA 02720-5923 - Phone
- (508) 676-3411
- Fax
- (508) 235-6656
- NPI assigned
- Apr 20, 2006
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 42866 | MA | Primary |
Addresses
Primary practice location
1030 President Ave
Suite 104 Southcoast Physician Services Inc
Fall River, MA 02720-5923
Mailing address
1030 President Ave
Suite 104 Southcoast Physician Services Inc
Fall River, MA 02720-5923
Phone (508) 676-3411
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000025599 | Other | RI | BLUE SHIELD |
| 764242 | Other | MA | TUFTS |
| 000000021256 | Other | MA | BMC HEALTHNET |
| 0016215 | Other | MA | NEIGHBORHOOD HEALTHPLAN |
| 004393 | Other | RI | BLUE CHIP |
| B10491301 | Other | MA | CIGNA |
| K08341 | Other | MA | BLUE SHIELD |
| 2069199 | Medicaid | MA | |
| 3684748 | Other | MA | HEALTHSOURCE |
| 0101462 | Other | MA | UNITED HEALTHCARE |
| 60417 | Other | MA | HARVARD PILGRIM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42866 | MA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southcoast Physician Services Inc | Past | Accepting new patients | |
| Southcoast Physicians Group, Inc. | Family Medicine | Past | Accepting new patients |
| Southcoast Physicians Group, Inc. | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1093770059",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1030 PRESIDENT AVE",
"address_2": "SUITE 104 SOUTHCOAST PHYSICIAN SERVICES INC",
"city": "FALL RIVER",
"state": "MA",
"postal_code": "027205923",
"telephone_number": "508-676-3411",
"fax_number": "508-235-6656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 PRESIDENT AVE",
"address_2": "SUITE 104 SOUTHCOAST PHYSICIAN SERVICES INC",
"city": "FALL RIVER",
"state": "MA",
"postal_code": "027205923",
"telephone_number": "508-676-3411",
"fax_number": "508-235-6656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAILLANCOURT",
"first_name": "HENRY",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-20",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MA",
"license": "42866",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "0000025599",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "764242",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BMC HEALTHNET",
"identifier": "000000021256",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEIGHBORHOOD HEALTHPLAN",
"identifier": "0016215",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHIP",
"identifier": "004393",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "B10491301",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "K08341",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2069199",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHSOURCE",
"identifier": "3684748",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "0101462",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "60417",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fall River, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.