Succor Primary Care Inc

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

SUCCOR PRIMARY CARE INC

Practice address

24 Crescent St Ste 407
Waltham, MA 02453-4309

Phone

(781) 358-8633

Fax

(781) 205-7602

NPI assigned

Mar 20, 2021

Organization subpart

No

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

Authorized official

Name

Lelia Janice Magoba, NURSE PRACTITIONERNPI 1649670027

Title

President

Phone

(781) 358-8633

Specialties & licenses 1

Addresses

Other names 1

• Succor Primary Care, P.C Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lelia J Magoba, APRN, CNP

  • Nurse Practitioner
  • Chelmsford, MA
  • NPI 1649670027
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1616198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1295311207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 CRESCENT ST STE 407",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024534309",
            "telephone_number": "781-358-8633",
            "fax_number": "781-205-7602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 CRESCENT ST STE 407",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024534309",
            "telephone_number": "781-358-8633",
            "fax_number": "781-205-7602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUCCOR PRIMARY CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-20",
        "last_updated": "2022-03-16",
        "certification_date": "2022-02-08",
        "status": "A",
        "authorized_official_last_name": "MAGOBA",
        "authorized_official_first_name": "LELIA",
        "authorized_official_middle_name": "JANICE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-358-8633",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "spc@succorpc.com",
            "affiliation": "N",
            "address_1": "24 Crescent St Ste 407",
            "city": "Waltham",
            "state": "MA",
            "country_code": "US",
            "postal_code": "024534309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Succor Primary Care, P.C",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Succor Primary Care, P.C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sandra Diane Stratford, MD, MSC
• Danielle Strauss
• Robert John Stravinsky, PT, DPT
• Kerri L Stuart, PT
• Melissa Sturtz
• Faith Rose Sudbey, LCSW
• Diane Marie Sullivan, B.A.
• Helen Rodolakis Sullivan, L.M.H.C.
• Joanne Marie Sullivan, NP
• Maryellen Sullivan, NP

• Primary Care Nurse Practitioner in Waltham, MA
• Providers in Waltham, MA by specialty
• Primary Care Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; 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.