SRC Springfield, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0899 Issued in MA

Legal business name

SRC SPRINGFIELD, INC.

Doing business as

Wingate at Springfield Rehab. & Skilled Nsg. Residence

Practice address

215 Bicentennial Hwy
Springfield, MA 01118-1962

Phone

(413) 796-7511

Fax

(413) 783-4020

NPI assigned

May 12, 2006

Last updated

Oct 5, 2012By 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

Ms. Tamilyn M. Levin, ESQ.

Title

Cfo

Phone

(781) 707-9510

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wingate at Springfield Rehab. & Skilled Nsg. Residence Doing business as

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349395200000",
    "number": "1265483796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 KENDRICK ST",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024942708",
            "telephone_number": "781-707-9085",
            "fax_number": "781-707-9285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 BICENTENNIAL HWY",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011181962",
            "telephone_number": "413-796-7511",
            "fax_number": "413-783-4020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRC SPRINGFIELD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2012-10-05",
        "status": "A",
        "authorized_official_last_name": "LEVIN",
        "authorized_official_first_name": "TAMILYN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "781-707-9510",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "ESQ."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MA",
            "license": "0899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110026479A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wingate at Springfield Rehab. & Skilled Nsg. Residence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Springfield Smiles Youth Dentistry, LLC
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• Karissa Ann Spurgeon, LMHC, M.ED.
• Maura J Squires, NP
• Chloe Hardy Squitiero, MA
• Aseesh Sreedharala, MD
• Harish Srinivasan, M.B.B.S.
• Julie P. St Amant, RRT
• Roger St Onge, DPT
• Kerri Danielle St. George, PA

• Skilled Nursing Facility in Springfield, MA
• Providers in Springfield, MA by specialty
• Skilled Nursing Facility in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2012; 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.