NPIMap

Organization Active NPI

Medical Center of Greater Mattapan

  • Physical Therapist
  • Mattapan, MA
National Provider Identifier
1144425059
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MEDICAL CENTER OF GREATER MATTAPAN
Practice address
1603 Blue Hill Ave
Mattapan, MA 02126-2122
Phone
(617) 296-5710
Fax
(617) 296-6368
NPI assigned
Jun 19, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Ruben Oganesov, M.D.NPI 1457562050
Title
President
Phone
(617) 783-5783

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

1603 Blue Hill Ave
Mattapan, MA 02126-2122

Mailing address

1603 Blue Hill Ave
Mattapan, MA 02126-2122
Phone (617) 296-5710

Other identifiers 1

IdentifierTypeStateIssuer
3057291MedicaidMA

National Provider Directory

National Provider Directory

Locations

1603 Blue Hill Ave
Mattapan, MA 02126
Phone (617) 296-5710

Practitioners & affiliated clinicians

Practitioners 3

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": "1182211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144425059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1603 BLUE HILL AVE",
            "city": "MATTAPAN",
            "state": "MA",
            "postal_code": "021262122",
            "telephone_number": "617-296-5710",
            "fax_number": "617-296-6368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1603 BLUE HILL AVE",
            "city": "MATTAPAN",
            "state": "MA",
            "postal_code": "021262122",
            "telephone_number": "617-296-5710",
            "fax_number": "617-296-6368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL CENTER OF GREATER MATTAPAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OGANESOV",
        "authorized_official_first_name": "RUBEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-783-5783",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3057291",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mattapan, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.