NPIMap

Organization Active NPI

Massachusetts Psychiatric Services, LLC

  • Psychiatry Physician
  • Sturbridge, MA
National Provider Identifier
1265989453
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MASSACHUSETTS PSYCHIATRIC SERVICES, LLC
Practice address
258 Main St
Sturbridge, MA 01566-1540
Phone
(508) 418-6888
Fax
(508) 418-6886
NPI assigned
Sep 6, 2016
Last updated
Jan 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2024

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

Authorized official

Name
Meenakshi Vemuri, MDNPI 1720066343
Title
Authorized
Phone
(508) 418-6888

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Social Worker 104100000X NU
Psychiatry Physician 2084P0800X NU Primary
Child & Adolescent Psychiatry Physician 2084P0804X NU

Addresses

Primary practice location

258 Main St
Sturbridge, MA 01566-1540

Mailing address

258 Main St
Sturbridge, MA 01566-1540
Phone (508) 418-6888

Other practice location 1

258 Main St
Sturbridge, MA 01566-1540
Phone (508) 418-6888 ext. 206

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170707001594 MA Part B Supplier - Clinic/Group Practice 4082983911 Receives reassigned benefits from 13 practitioners
Practice locations: Sturbridge, MA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D2269353Massachusetts Psychiatric Services258 Main Street, Sturbridge, MA 01566Certificate of waiverSep 25, 2026

National Provider Directory

National Provider Directory

Locations

258 Main St
Sturbridge, MA 01566
Phone (508) 418-6888

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1473120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704844800000",
    "number": "1265989453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 MAIN ST",
            "city": "STURBRIDGE",
            "state": "MA",
            "postal_code": "015661540",
            "telephone_number": "508-418-6888",
            "fax_number": "508-418-6886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "258 MAIN ST",
            "city": "STURBRIDGE",
            "state": "MA",
            "postal_code": "015661540",
            "telephone_number": "508-418-6888",
            "fax_number": "508-418-6886"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "258 Main St",
            "address_purpose": "LOCATION",
            "city": "Sturbridge",
            "state": "MA",
            "postal_code": "015661540",
            "country_code": "US",
            "telephone_number": "508-418-6888 x206",
            "fax_number": "508-418-6886",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MASSACHUSETTS PSYCHIATRIC SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-06",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A",
        "authorized_official_last_name": "VEMURI",
        "authorized_official_first_name": "MEENAKSHI",
        "authorized_official_title_or_position": "AUTHORIZED",
        "authorized_official_telephone_number": "508-418-6888",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sturbridge, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.