NPIMap

Organization Active NPI

Good Samaritan Medical Practice Corp

  • Specialist
  • Brockton, MA
National Provider Identifier
1285625137
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
GOOD SAMARITAN MEDICAL PRACTICE CORP
Practice address
235 N Pearl St
Good Samaritan Medical Center
Brockton, MA 02301-1794
Phone
(617) 562-5482
Fax
(617) 562-5415
NPI assigned
Oct 31, 2005
Last updated
Aug 22, 2020By the provider in NPPES
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
Mr. John J Holiver
Title
Director
Phone
(617) 562-5482

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

235 N Pearl St
Good Samaritan Medical Center
Brockton, MA 02301-1794

Mailing address

77 Warren St
Provider Enrollment
Brighton, MA 02135-3601
Phone (617) 562-5482

Other identifiers 1

IdentifierTypeStateIssuer
9779213MedicaidMA

National Provider Directory

National Provider Directory

Locations

1440 Pleasant St
Ste D
Bridgewater, MA 02324
Phone (508) 697-8116

907 Sumner St
Ste 202
Stoughton, MA 02072
Phone (781) 297-8020

Practitioners & affiliated clinicians

Practitioners 59

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 59

NPI Registry JSON

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285625137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 WARREN ST",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021353601",
            "telephone_number": "617-562-5482",
            "fax_number": "617-562-5415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 N PEARL ST",
            "address_2": "GOOD SAMARITAN MEDICAL CENTER",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023011794",
            "telephone_number": "617-562-5482",
            "fax_number": "617-562-5415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN MEDICAL PRACTICE CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLIVER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "617-562-5482",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9779213",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, 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.