NPIMap

Organization Active NPI

Community Caring Clinic LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Roxbury, MA
National Provider Identifier
1184112377
Registry record updated Apr 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
COMMUNITY CARING CLINIC LLC
Doing business as
Community Caring Clinic LLC
Practice address
55 Warren St
Roxbury, MA 02119-3235
Phone
(617) 858-7880
NPI assigned
Apr 24, 2018
Last updated
Apr 24, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2018

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

Authorized official

Name
Abdifatah H AhmedNPI 1558695452
Title
President
Phone
(617) 858-7880

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
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

55 Warren St
Roxbury, MA 02119-3235

Mailing address

PO Box 190683
Roxbury, MA 02119-0013
Phone (617) 858-7880

Other names 1

  • Community Caring Clinic LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190424001826 MA Part B Supplier - Clinic/Group Practice 6002158987 Receives reassigned benefits from 14 practitioners
Practice locations: Roxbury, MA

National Provider Directory

National Provider Directory

Locations

55 Warren St
Roxbury, MA 02119
Phone (617) 541-1829

55 State St
Ste 202
Springfield, MA 01103

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1524528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524528000000",
    "number": "1184112377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190683",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021190013",
            "telephone_number": "617-858-7880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 WARREN ST",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021193235",
            "telephone_number": "617-858-7880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARING CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-24",
        "last_updated": "2018-04-24",
        "status": "A",
        "authorized_official_last_name": "AHMED",
        "authorized_official_first_name": "ABDIFATAH",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-858-7880"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Caring Clinic LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roxbury, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2018; 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.