NPIMap

Organization Active NPI

The McLean Hospital Corporation

Doing business as McLean Professional Practice Group

  • Psychiatry Physician
  • Belmont, MA
National Provider Identifier
1114979580
Registry record updated Oct 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
THE MCLEAN HOSPITAL CORPORATION
Doing business as
McLean Professional Practice Group
Practice address
115 Mill St
Belmont, MA 02478-1041
Phone
(617) 855-2183
Fax
(617) 855-3745
NPI assigned
May 16, 2006
Last updated
Oct 27, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2010

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

Authorized official

Name
Joseph Gold, M.D.NPI 1316013493
Title
Chief Medical Officer
Phone
(617) 855-2367

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Nurse Specialist 364S00000X NU
Clinical Psychologist 103TC0700X NU
Clinical Social Worker 1041C0700X NU
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

115 Mill St
Belmont, MA 02478-1041

Mailing address

P.O. Box 5-0397
Woburn, MA 01815-0397
Phone (617) 855-2183

Other identifiers 4

IdentifierTypeStateIssuer
1201174MedicaidMA
M16400OtherMABC/BS
W10374OtherMABC/BS
9778705MedicaidMA

Other names 1

  • McLean Professional Practice Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040323001228 MA Part B Supplier - Clinic/Group Practice 9436040961 Receives reassigned benefits from 405 practitioners
Practice locations: Belmont, MA; Middleboro, MA; Petersham, MA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
McLean Hospital Corporation4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

216 Lake Rd
Ashburnham, MA 01430
Phone (800) 230-8764

115 Mill St
#102
Belmont, MA 02478

52 Oak St
Middleboro, MA 02346
Phone (508) 923-5300

Interoperability endpoints

  • Direct secure messaging: abate.maura.mcl@direct.partners.masshiway.net
  • Direct secure messaging: akoun.kayia.mcl@direct.partners.masshiway.net
  • Direct secure messaging: alperovitz.david.mcl@direct.partners.masshiway.net
  • Direct secure messaging: aranow.robert.mcl@direct.partners.masshiway.net
  • Direct secure messaging: ardery.jackson.mcl@direct.partners.masshiway.net
  • Direct secure messaging: aubrey.kevin.mcl@direct.partners.masshiway.net
  • Direct secure messaging: bader.caroline.mcl@direct.partners.masshiway.net
  • Direct secure messaging: baranowski.kimberly.mcl@direct.partners.masshiway.net
  • Direct secure messaging: basilico.matthew.mcl@direct.partners.masshiway.net
  • Direct secure messaging: batejan.kristen.mcl@direct.partners.masshiway.net
  • Direct secure messaging: bautista.roan.mcl@direct.partners.masshiway.net
  • Direct secure messaging: bedell.diane.mcl@direct.partners.masshiway.net
  • Direct secure messaging: beland.john.mcl@direct.partners.masshiway.net
  • Direct secure messaging: beville.kristin.mcl@direct.partners.masshiway.net
  • Direct secure messaging: bhatti.nasir.mcl@direct.partners.masshiway.net
  • Direct secure messaging: billingsley.benjamin.mcl@direct.partners.masshiway.net
  • Direct secure messaging: bjorgvinsson.throstur.mcl@direct.partners.masshiway.net
  • Direct secure messaging: bogunovic-sotelo.olivera.mcl@direct.partners.masshiway.net
  • Direct secure messaging: bolton.kirsten.mcl@direct.partners.masshiway.net
  • Direct secure messaging: bolton.paula.mcl@direct.partners.masshiway.net

Practitioners & affiliated clinicians

Practitioners 563

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.

View all 563

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288137600000",
    "number": "1114979580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 5-0397",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018150397",
            "telephone_number": "617-855-2183",
            "fax_number": "617-855-3745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 MILL ST",
            "city": "BELMONT",
            "state": "MA",
            "postal_code": "024781041",
            "telephone_number": "617-855-2183",
            "fax_number": "617-855-3745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MCLEAN HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2010-10-27",
        "status": "A",
        "authorized_official_last_name": "GOLD",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "617-855-2367",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1201174",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "M16400",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "W10374",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9778705",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McLean Professional Practice Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Belmont, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2010; 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.