NPIMap

Organization Active NPI

Groton Medical Wellness Spa LLC

  • General Practice Physician
  • Groton, MA
National Provider Identifier
1275796351
Registry record updated Oct 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
GROTON MEDICAL WELLNESS SPA LLC
Practice address
493 Main Street
Groton, MA 01450
Phone
(978) 449-9919
NPI assigned
Jul 8, 2008
Last updated
Oct 16, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2009

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

Authorized official

Name
Mrs. Jean M Nordin-Evans, DDS
Title
Owner
Phone
(978) 449-9919

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X NU
General Practice Physician 208D00000X NU Primary
Massage Therapist 225700000X NU

Addresses

Primary practice location

493 Main Street
Groton, MA 01450

Mailing address

493 Main St
Groton, MA 01450-4254
Phone (978) 449-9919

National Provider Directory

National Provider Directory

Locations

493 Main St
Groton, MA 01450
Phone (978) 449-9772

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1215475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255651200000",
    "number": "1275796351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "493 MAIN ST",
            "city": "GROTON",
            "state": "MA",
            "postal_code": "014504254",
            "telephone_number": "978-449-9919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "493 MAIN STREET",
            "city": "GROTON",
            "state": "MA",
            "postal_code": "01450",
            "telephone_number": "978-449-9919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GROTON MEDICAL WELLNESS SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-08",
        "last_updated": "2009-10-16",
        "status": "A",
        "authorized_official_last_name": "NORDIN-EVANS",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "978-449-9919",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Groton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2009; 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.