NPIMap

Organization Active NPI

Centre Pediatric Associates PC

  • Pediatrics Physician
  • Brookline, MA
National Provider Identifier
1336212422
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
NA
Legal business name
CENTRE PEDIATRIC ASSOCIATES PC
Practice address
1 Brookline PL
Suite 327
Brookline, MA 02445-7224
Phone
(617) 735-8585
Fax
(617) 232-0572
NPI assigned
Nov 16, 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
Bruce Willard Bunnell, M.D.NPI 1205827821
Title
President
Phone
(617) 735-8585

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X NA Primary

Addresses

Primary practice location

1 Brookline PL
Suite 327
Brookline, MA 02445-7224

Mailing address

1 Brookline PL
Suite 327
Brookline, MA 02445-7224
Phone (617) 735-8585

Other identifiers 4

IdentifierTypeStateIssuer
92057OtherMAAETNA USHEALTHCARE
9767312MedicaidMA
711716OtherMATUFTS
M14606OtherMABLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

1 Brookline Pl
Ste 327
Brookline, MA 02445
Phone (617) 735-8585

Interoperability endpoints

  • Direct secure messaging: degirolami.laura.centr@direct.partners.masshiway.net
  • Direct secure messaging: boccuzzi.lauren.centr@direct.partners.masshiway.net
  • Direct secure messaging: jaklitsch.bridget.centr@direct.partners.masshiway.net
  • Direct secure messaging: sun.julie.centr@direct.partners.masshiway.net
  • Direct secure messaging: amin.parag.centr@direct.partners.masshiway.net
  • Direct secure messaging: ma.michael.centr@direct.partners.masshiway.net
  • Direct secure messaging: bruntrager.anne.centr@direct.partners.masshiway.net
  • Direct secure messaging: daley.tracey.centr@direct.partners.masshiway.net
  • Direct secure messaging: bunnell.bruce.centr@direct.partners.masshiway.net

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336212422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BROOKLINE PL",
            "address_2": "SUITE 327",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024457224",
            "telephone_number": "617-735-8585",
            "fax_number": "617-232-0572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BROOKLINE PL",
            "address_2": "SUITE 327",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024457224",
            "telephone_number": "617-735-8585",
            "fax_number": "617-232-0572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRE PEDIATRIC ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUNNELL",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "WILLARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-735-8585",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": "NA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA USHEALTHCARE",
            "identifier": "92057",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9767312",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "711716",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "M14606",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookline, 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.