NPIMap

Organization Active NPI

Cambridge Public Health Commission

Doing business as Cambridge Health Alliance Outpatient Pharmacy Revere

  • Community/Retail Pharmacy
  • Revere, MA
National Provider Identifier
1134812647
Registry record updated Jun 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
CAMBRIDGE PUBLIC HEALTH COMMISSION
Doing business as
Cambridge Health Alliance Outpatient Pharmacy Revere
Practice address
454 Broadway
Revere, MA 02151-3034
Phone
(781) 485-8272
NPI assigned
May 31, 2023
Last updated
Jun 2, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2023

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

Authorized official

Name
Maria KossilosNPI 1982988705
Title
Associate Chief Pharmacy Officer
Phone
(617) 806-8505

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

454 Broadway
Revere, MA 02151-3034

Mailing address

454 Broadway
Revere, MA 02151-3034
Phone (781) 485-8272

Other names 1

  • Cambridge Health Alliance Outpatient Pharmacy Revere Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200914000845 MA Part B Supplier - Pharmacy 8921910894 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Revere, MA; Cambridge, MA; Medford, MA; Malden, MA

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Cambridge Hospital Anes44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

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

View all 43

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1685491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685664000000",
    "number": "1134812647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "454 BROADWAY",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021513034",
            "telephone_number": "781-485-8272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "454 BROADWAY",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021513034",
            "telephone_number": "781-485-8272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMBRIDGE PUBLIC HEALTH COMMISSION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-31",
        "last_updated": "2023-06-02",
        "certification_date": "2023-06-02",
        "status": "A",
        "authorized_official_last_name": "KOSSILOS",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "ASSOCIATE CHIEF PHARMACY OFFICER",
        "authorized_official_telephone_number": "617-806-8505"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cambridge Health Alliance Outpatient Pharmacy Revere",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cambridge Health Alliance Outpatient Pharmacy Revere",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Revere, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; 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.