Brockton Hospital Specialty Physician Group

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

BROCKTON HOSPITAL SPECIALTY PHYSICIAN GROUP

Doing business as

Signature Healthcare Brockton Hospital

Practice address

680 Centre St
Brockton, MA 02302-3308

Phone

(508) 941-7062

Fax

(508) 941-6337

NPI assigned

May 31, 2006

Last updated

Dec 22, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Eugene C. Wallace

Title

Ceo

Phone

(508) 941-7062

Specialties & licenses 15

Addresses

Other identifiers 2

Other names 1

• Signature Healthcare Brockton Hospital Doing business as

Practitioners 9

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.

• Samar A Choubah, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Brockton, MA
  • NPI 1588698245
  NPD (past)
• Jean-Pierre M. Geagea, M.D.

  • Interventional Cardiology Physician
  • Brockton, MA
  • NPI 1104884022

  Cardiovascular Disease

  NPD (past)
• Steven Lane, M.D.

  • Radiation Oncology Physician
  • Brockton, MA
  • NPI 1346235256
  NPD (past)
• Ludwine D Paul, APRN,BC

  • Acute Care Nurse Practitioner
  • Boston, MA
  • NPI 1679671382
  NPD (past)
• Cory Pickering, PA

  • Physician Assistant
  • Brockton, MA
  • NPI 1437502697
  NPD (past)
• Stephen L Malone, M.D.

  • Orthopaedic Surgery of the Spine Physician
  • Dover, DE
  • NPI 1356377204
  NPD (past)
• Allen Yicheng Rossetti-Chung, M.D., PH.D.

  • Radiation Oncology Physician
  • Providence, RI
  • NPI 1669834552
  NPD (past)
• Melissa Joy Tracy, MD

  • Cardiovascular Disease Physician
  • Chicago, IL
  • NPI 1639154370
  NPD (past)
• Julie G White, M.D.

  • Vascular Surgery Physician
  • Rockport, ME
  • NPI 1740206002
  NPD (past)

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261440000000",
    "number": "1174560304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 847493",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022847493",
            "telephone_number": "508-565-0147",
            "fax_number": "508-565-0157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 CENTRE ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023023308",
            "telephone_number": "508-941-7062",
            "fax_number": "508-941-6337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROCKTON HOSPITAL SPECIALTY PHYSICIAN GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2009-12-22",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "508-941-7062"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9757350",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP #",
            "identifier": "M19115",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Signature Healthcare Brockton Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brockton Health Center, LLC
• Brockton Healthcare Clinic LLC (Brockton Regional Kidney Center)
• Brockton Healthcare Services LLC
• Brockton Home Health Afc (Brockton Home Health Care AFC)
• Brockton Home Health Care Agency (Brockton HHA)
• Brockton Hospital, Inc. (Signature Healthcare Brockton Hospital)
• Brockton Hospital, Inc. (Signature Healthcare Pharmacy)
• Brockton Hospital, Inc. (Signature Healthcare Brockton Hospital)
• Brockton Hospital, Inc. (Signature Healthcare Pharmacy)
• Brockton Hospital, Inc. (Signature Healthcare Brockton Hospital)

• Internal Medicine Physician in Brockton, MA
• Providers in Brockton, MA by specialty
• Internal Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2009; 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.