NPIMap

Organization Active NPI

South Cove Community Health Center, Inc.

  • Community/Retail Pharmacy
  • Boston, MA
National Provider Identifier
1235985193
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SOUTH COVE COMMUNITY HEALTH CENTER, INC.
Practice address
256 Harrison Ave
Boston, MA 02111-1835
Phone
(617) 482-7419
Fax
(617) 482-6162
NPI assigned
Apr 30, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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

Authorized official

Name
Mr. Eric Tiberi
Title
Chief Executive Officer
Phone
(617) 521-6708

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

256 Harrison Ave
Boston, MA 02111-1835

Mailing address

145 South St
Boston, MA 02111-2826
Phone (617) 521-6708

Other names 1

  • SCCHC Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240910003057 MA Part B Supplier - Pharmacy 8325939952 Practice locations: Boston, MA

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
South Cove Comm Health7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

145 South St
Fl 2
Boston, MA 02111

Practitioners & affiliated clinicians

Practitioners 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1714435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714435200000",
    "number": "1235985193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 SOUTH ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021112826",
            "telephone_number": "617-521-6708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "256 HARRISON AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021111835",
            "telephone_number": "617-482-7419",
            "fax_number": "617-482-6162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COVE COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-30",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "TIBERI",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "617-521-6708",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SCCHC Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; 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.