NPIMap

Organization Active NPI

Dimock Community Health Center

  • Community Health Clinic/Center
  • Roxbury, MA
National Provider Identifier
1336563188
Registry record updated Feb 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
DIMOCK COMMUNITY HEALTH CENTER
Practice address
55 Dimock St
Credentialing Office
Roxbury, MA 02119-1029
Phone
(617) 442-8800
Fax
(617) 427-2784
NPI assigned
Feb 14, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2014

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

Authorized official

Name
Kerlley Aime'
Title
Credentialing Coordinator
Phone
(617) 442-8800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

55 Dimock St
Credentialing Office
Roxbury, MA 02119-1029

Mailing address

55 Dimock St
Credentialing Office
Roxbury, MA 02119-1029
Phone (617) 442-8800

Other identifiers 1

IdentifierTypeStateIssuer
M21066OtherMAMEDICARE PTAN

Other names 1

  • The Dimock Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dimock Community Health Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

55 Dimock St
Ofc
Roxbury, MA 02119

NPI Registry JSON

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

{
    "created_epoch": "1392336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392336000000",
    "number": "1336563188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 DIMOCK ST",
            "address_2": "CREDENTIALING OFFICE",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021191029",
            "telephone_number": "617-442-8800",
            "fax_number": "617-427-2784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 DIMOCK ST",
            "address_2": "CREDENTIALING OFFICE",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021191029",
            "telephone_number": "617-442-8800",
            "fax_number": "617-427-2784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIMOCK COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-14",
        "last_updated": "2014-02-14",
        "status": "A",
        "authorized_official_last_name": "AIME'",
        "authorized_official_first_name": "KERLLEY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "617-442-8800"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "M21066",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Dimock Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roxbury, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2014; 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.