NPIMap

Organization Active NPI

Boston Health Care for the Homeless Program, Inc.

  • Federally Qualified Health Center (FQHC)
  • Boston, MA
National Provider Identifier
1205080348
Registry record updated May 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
4LQX Issued in MA
Legal business name
BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM, INC.
Practice address
444 Harrison Ave
Boston, MA 02118
Phone
(857) 654-1850
Fax
(857) 654-1433
NPI assigned
Nov 14, 2008
Last updated
May 24, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2018

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

Authorized official

Name
Agnes W Leung
Title
Chief Financial Officer
Phone
(857) 654-1200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 4LQX MA Primary

Addresses

Primary practice location

444 Harrison Ave
Boston, MA 02118

Mailing address

780 Albany St
Boston, MA 02118-2755
Phone (857) 654-1227

Other names 1

  • Pine Street Inn - Men's Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060816000296 MA Part A Provider - Federally Qualified Health Center (FQHC) 2668475419 1 other NPI on this enrollment
Practice locations: Boston, MA
O20110527000309 MA Part B Supplier - Clinic/Group Practice 2668475419 Receives reassigned benefits from 139 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Roxbury, MA; Quincy, MA; Jamaica Plain, MA; Boston, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205080348. Details of each certification follow.

Federally qualified health center certification: CCN 221870

Legal name
BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM, INC.
Doing business as
MCINNIS HEALTH GROUP
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 2, 2006
Last certification
Oct 2, 2006
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 5, 1992 in MA
Enrollment address
444 Harrison Ave
Boston, MA 21182404
Related CCNs
221814

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Tax ID family
Boston Health Care for the Homeless Program Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Steve Tringale Individual Corporate DirectorBoard Member Aug 8, 2006 5%
Deion Scott Hawkins Individual Corporate DirectorBoard Member Jul 11, 2023 5%
Sara Gaia Reid Individual Corporate DirectorBoard Member May 12, 2015 5%
Derek Winbush Individual Corporate DirectorBoard Member Sep 14, 2010 5%
Paul Jeremiah Selian Individual Corporate DirectorBoard Member Jul 11, 2023 5%
Alice Kenney Walsh Individual Corporate DirectorBoard Member Jan 13, 2026 5%
Brett Painchaud Individual Corporate DirectorBoard Member Jul 8, 2008 5%
Denise de Las Nueces Individual Corporate OfficerCeo Apr 14, 2026
W-2 Managing Employee Jul 9, 2012
Joanne M Guarino Individual Corporate DirectorBoard Member Jun 12, 2012 5%
Steven Myles Walsh Individual Corporate DirectorBoard Member Jan 12, 2016 5%
Thomas Dehner Individual Corporate DirectorBoard Member Aug 9, 2011 5%
Barbara Blakeney Individual Corporate DirectorBoard Member Jul 14, 2009 5%
Francis Hyatt Individual Corporate DirectorBoard Member Nov 12, 2019 5%
Agnes Leung Individual Corporate OfficerCfo Jun 13, 2000
W-2 Managing EmployeeChief Financial Office Aug 8, 2006
Ryan William O'Donnell Individual Corporate DirectorBoard Member Aug 14, 2018 5%
Valeria Anita Ramdin Individual Corporate DirectorBoard Member Jul 12, 2016 5%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 6

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": "1226620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527120000000",
    "number": "1205080348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 ALBANY ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182755",
            "telephone_number": "857-654-1227",
            "fax_number": "857-654-1404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 HARRISON AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02118",
            "telephone_number": "857-654-1850",
            "fax_number": "857-654-1433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-14",
        "last_updated": "2018-05-24",
        "status": "A",
        "authorized_official_last_name": "LEUNG",
        "authorized_official_first_name": "AGNES",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "857-654-1200"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MA",
            "license": "4LQX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Street Inn - Men's Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Pine Street Inn - Men's Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.