NPIMap

Organization Active NPI

Shriver Clinical Services Corporation

  • Internal Medicine Physician
  • Wakefield, MA
National Provider Identifier
1225014616
Registry record updated Feb 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SHRIVER CLINICAL SERVICES CORPORATION
Practice address
607 North Ave
Door 14
Wakefield, MA 01880-1301
Phone
(781) 279-1260
NPI assigned
Dec 19, 2005
Last updated
Feb 22, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2011

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

Authorized official

Name
Ms. Suzanne Cavallari
Title
Manager
Phone
(508) 384-5567

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

607 North Ave
Door 14
Wakefield, MA 01880-1301

Mailing address

591 North Ave
Door 2
Wakefield, MA 01880-1647
Phone (781) 279-1260

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040629001280 MA Part B Supplier - Clinic/Group Practice 9739165648 Receives reassigned benefits from 16 practitioners
Practice locations: Wrentham, MA

National Provider Directory

National Provider Directory
Tax ID family
Shriver Clinical Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

591 North Ave
#2
Wakefield, MA 01880
Phone (781) 246-8588

32 Franklin St
Ste 402
Worcester, MA 01608
Phone (508) 754-8405

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298332800000",
    "number": "1225014616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "591 NORTH AVE",
            "address_2": "DOOR 2",
            "city": "WAKEFIELD",
            "state": "MA",
            "postal_code": "018801647",
            "telephone_number": "781-279-1260",
            "fax_number": "781-279-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 NORTH AVE",
            "address_2": "DOOR 14",
            "city": "WAKEFIELD",
            "state": "MA",
            "postal_code": "018801301",
            "telephone_number": "781-279-1260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHRIVER CLINICAL SERVICES CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-19",
        "last_updated": "2011-02-22",
        "status": "A",
        "authorized_official_last_name": "CAVALLARI",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "508-384-5567",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wakefield, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2011; 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.