NPIMap

Organization Active NPI

Internal Medicine PC

  • Internal Medicine Physician
  • Agawam, MA
National Provider Identifier
1275593758
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
INTERNAL MEDICINE PC
Practice address
377 Walnut Street Extension
Agawam, MA 01001
Phone
(413) 786-7217
Fax
(413) 786-7219
NPI assigned
Mar 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Lynn A McDonald
Title
Comptroller
Phone
(413) 786-4700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

377 Walnut Street Extension
Agawam, MA 01001

Mailing address

PO Box 788
377 Walnut Street Extension
Agawam, MA 01001
Phone (413) 786-7217

Other identifiers 1

IdentifierTypeStateIssuer
INM12149OtherMABCBS MA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275593758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 788",
            "address_2": "377 WALNUT STREET EXTENSION",
            "city": "AGAWAM",
            "state": "MA",
            "postal_code": "01001",
            "telephone_number": "413-786-7217",
            "fax_number": "413-786-7219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "377 WALNUT STREET EXTENSION",
            "city": "AGAWAM",
            "state": "MA",
            "postal_code": "01001",
            "telephone_number": "413-786-7217",
            "fax_number": "413-786-7219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "COMPTROLLER",
        "authorized_official_telephone_number": "413-786-4700",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MA",
            "identifier": "INM12149",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Agawam, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.