NPIMap

Organization Active NPI

Edward M. Kennedy Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Framingham, MA
National Provider Identifier
1154600344
Registry record updated Jan 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC
Practice address
354 Waverly St
Framingham, MA 01702-7079
Phone
(508) 370-0113
Fax
(508) 370-3637
NPI assigned
Aug 5, 2011
Organization subpart
Yes
Parent organization
EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 25, 2023

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

Authorized official

Name
Mr. Stephen J Kerrigan
Title
President/Ceo
Phone
(508) 854-2122

Specialties & licenses 1

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

Addresses

Primary practice location

354 Waverly St
Framingham, MA 01702-7079

Mailing address

115 NE Cutoff Ste 200
Worcester, MA 01606-1224
Phone (508) 854-2122

Other identifiers 1

IdentifierTypeStateIssuer
110022061EMedicaidMA

Other names 1

  • Great Brook Valley Health Center Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120627000005 MA Part A Provider - Federally Qualified Health Center (FQHC) 3476512740 Practice locations: Framingham, MA

Federally qualified health center certification: CCN 221913

Legal name
EDWARD M KENNEDY COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 17, 2012
Last certification
Jul 17, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 6, 1972 in MA
Enrollment address
354 Waverly Street
Framingham, MA 17027079

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Edward M Kennedy Community Health Center Inc9 organizations share this tax ID, including this one
Part of
Edward M Kennedy Community Health Center Inc

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Susan Seppa Individual Corporate DirectorBoard Member Jul 1, 2019
Jennifer Ehrlich Individual Corporate DirectorBoard Member Jul 1, 2019
Valerie Zolezzi-Wyndham Individual Corporate Director Nov 4, 2008
George W Manigault Individual Corporate DirectorBoard Member Jul 1, 2019
Stephen J Kerrigan Individual Corporate OfficerPresident and Ceo Jul 2, 2019 100%
Corporate DirectorPresident and Ceo Jul 2, 2019 100%
W-2 Managing EmployeePresident and Ceo Jul 2, 2019 100%
Operational/Managerial ControlPresident and Ceo Jul 2, 2019 100%
Aivi Nguyen Individual Corporate DirectorBoard Member Jul 1, 2019
Jonna Gifford Individual Corporate DirectorBoard Member Jul 1, 2019
Gail F Hormats Individual Corporate Director Jun 26, 2007
Christopher J Wilbur Individual Corporate DirectorCfo(Interim) and Director of Acc Mar 3, 2020 100%
W-2 Managing EmployeeCfo(Interim) and Director of Acc Mar 3, 2020 100%
Operational/Managerial ControlCfo(Interim) and Director of Acc Mar 3, 2020 100%
Stuart Pynn Individual Corporate DirectorBoard Member May 1, 2012
Ajayi Harris Individual Corporate DirectorBoard Member Jul 1, 2019
Raul Porras Individual Corporate DirectorBoard Member Jul 1, 2019
David J Small Individual Corporate DirectorVice President of Human Resource Jul 1, 2019 100%
W-2 Managing EmployeeVice President of Human Resource Jul 1, 2019 100%
Operational/Managerial ControlVice President of Human Resource Jul 1, 2019 100%

Practitioners & affiliated clinicians

Practitioners 65

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 65

NPI Registry JSON

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

{
    "created_epoch": "1312502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674604800000",
    "number": "1154600344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 NE CUTOFF STE 200",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016061224",
            "telephone_number": "508-854-2122",
            "fax_number": "508-853-8593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 WAVERLY ST",
            "city": "FRAMINGHAM",
            "state": "MA",
            "postal_code": "017027079",
            "telephone_number": "508-370-0113",
            "fax_number": "508-370-3637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC",
        "enumeration_date": "2011-08-05",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A",
        "authorized_official_last_name": "KERRIGAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "508-854-2122",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110022061E",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Brook Valley Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Great Brook Valley Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Framingham, MA

Sources for this page

Verify at the official NPI Registry.