NPIMap

Organization Active NPI

MMDS of Boston

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Manchester, NH
National Provider Identifier
1295106136
Registry record updated Oct 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X
License
1943M Issued in NH
Legal business name
MMDS OF BOSTON
Practice address
95 Eddy Rd
Suite 611
Manchester, NH 03102-3266
Phone
(617) 244-9729
Fax
(617) 244-9730
NPI assigned
Oct 19, 2015
Last updated
Oct 19, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2015

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

Authorized official

Name
Mr. Richard Scott Grinley, M.ED.
Title
President/Ceo
Phone
(617) 244-9729

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X 1943M NH Primary

Addresses

Primary practice location

95 Eddy Rd
Suite 611
Manchester, NH 03102-3266

Mailing address

48 Silver Lake Ave
Newton, MA 02458-1111
Phone (617) 244-9729

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295106136. Details of each certification follow.

Portable X-ray supplier certification: CCN 30X0009803

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MMDS OF BOSTON, LLC
Certification status
Active
Provider type (POS)
Portable X-ray supplier
Participating since
Feb 24, 2016
Last certification
Feb 22, 2023
Ownership / control type
Individual
Facility address
95 Eddy Road
Manchester, NH 03102

National Provider Directory

National Provider Directory
Tax ID family
MMDS of Boston LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

95 Eddy Rd
Ste 611
Manchester, NH 03102
Phone (617) 244-9729

NPI Registry JSON

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

{
    "created_epoch": "1445212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445212800000",
    "number": "1295106136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 SILVER LAKE AVE",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024581111",
            "telephone_number": "617-244-9729",
            "fax_number": "617-244-9730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 EDDY RD",
            "address_2": "SUITE 611",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031023266",
            "telephone_number": "617-244-9729",
            "fax_number": "617-244-9730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMDS OF BOSTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-19",
        "last_updated": "2015-10-19",
        "status": "A",
        "authorized_official_last_name": "GRINLEY",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "617-244-9729",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.ED."
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "NH",
            "license": "1943M",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, NH

Sources for this page

Verify at the official NPI Registry.