NPIMap

Organization Active NPI

North Shore Community Health, Inc

Doing business as Peabody Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Peabody, MA
National Provider Identifier
1124373022
Registry record updated Sep 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
4M9K Issued in MA
Legal business name
NORTH SHORE COMMUNITY HEALTH, INC
Doing business as
Peabody Family Health Center
Practice address
89 Foster St
Peabody, MA 01960-8925
Phone
(978) 532-4903
Fax
(978) 532-4995
NPI assigned
Jul 17, 2012
Last updated
Sep 27, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTH SHORE COMMUNITY HEALTH, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 27, 2012

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

Authorized official

Name
Margaret Brennan, MPH
Title
Ceo
Phone
(978) 825-1109

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 4M9K MA Primary

Addresses

Primary practice location

89 Foster St
Peabody, MA 01960-8925

Mailing address

27 Congress St
Suite 103
Salem, MA 01970-7309
Phone (978) 744-8388

Other names 1

  • Peabody Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040812001007 MA Part B Supplier - Clinic/Group Practice 4880666452 Receives reassigned benefits from 45 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salem, MA
O20130823000494 MA Part A Provider - Federally Qualified Health Center (FQHC) 4880666452 Practice locations: Peabody, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124373022. Details of each certification follow.

Federally qualified health center certification: CCN 221916

Legal name
NORTH SHORE COMMUNITY HEALTH INC
Doing business as
PEABODY FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 22, 2013
Last certification
Apr 22, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1977 in MA
Enrollment address
89 Foster St
Peabody, MA 19608925

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
North Shore Cummunity H

Locations

89 Foster St
Peabody, MA 01960
Phone (978) 532-4903

27 Congress St
Ste 513
Salem, MA 01970
Phone (978) 825-1175

47 Congress St
Salem, MA 01970
Phone (978) 744-8388

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tammy Lamonde Individual Corporate DirectorBoard Member Apr 25, 2019
Michael L. Babb Individual Corporate DirectorBoard Member - Clerk Jun 30, 2015
Peter Kent Individual Corporate DirectorBoard Member - Clerk Jul 18, 2018
Maureen M Aylward Individual Corporate DirectorBoard Member - Clerk Jun 30, 2017
Lucy Corchado Individual Corporate DirectorBoard Member - Vice Chair Jun 30, 2015
Jack J Vondras Individual Corporate DirectorBoard Member - Chair Jun 30, 2015
Pamela J Paine Individual Corporate DirectorBoard Member - Clerk Jun 30, 2015
Robert Tolu Individual Corporate DirectorBoard Member - Treasurer Jun 30, 2016
Margaret Brennan Individual Corporate OfficerCeo Apr 22, 2013
W-2 Managing EmployeeCeo Apr 22, 2013
Amy Leach Individual Corporate DirectorBoard Member - Clerk Jul 18, 2018
Marc Bourassa Individual Corporate OfficerCfo Oct 12, 2017
Operational/Managerial ControlCfo Oct 12, 2017
Damian Archer Individual Corporate OfficerCmo May 8, 2017
Operational/Managerial ControlCmo May 8, 2017
William Sullivan Individual Corporate DirectorBoard Member - Clerk Jul 18, 2018
Marion E. Winfrey Individual Corporate DirectorBoard Member - Clerk Jun 30, 2015

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
North Shore Community Health IncSalem, MA, CCN 221917 Federally qualified health center Operational/Managerial Control Sep 12, 2011
Peabody Veterans Memorial High School Student Health CenterPeabody, MA, CCN 221932 Federally qualified health center Operational/Managerial Control Jun 25, 2015
North Shore Community Health IncSalem, MA, CCN 221946 Federally qualified health center Operational/Managerial Control May 1, 2017

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348704000000",
    "number": "1124373022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 CONGRESS ST",
            "address_2": "SUITE 103",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019707309",
            "telephone_number": "978-744-8388",
            "fax_number": "978-744-0079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 FOSTER ST",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019608925",
            "telephone_number": "978-532-4903",
            "fax_number": "978-532-4995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE COMMUNITY HEALTH, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH SHORE COMMUNITY HEALTH, INC",
        "enumeration_date": "2012-07-17",
        "last_updated": "2012-09-27",
        "status": "A",
        "authorized_official_last_name": "BRENNAN",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "978-825-1109",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MA",
            "license": "4M9K",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peabody Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peabody, MA

Sources for this page

Verify at the official NPI Registry.