NPIMap

Organization Active NPI

Revere Medical of Massachusetts, PC

  • Internal Medicine Physician
  • Brockton, MA
National Provider Identifier
1336976539
Registry record updated Jun 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
REVERE MEDICAL OF MASSACHUSETTS, PC
Practice address
1 Pearl St Ste 2100
Brockton, MA 02301-2868
Phone
(508) 897-6040
NPI assigned
Sep 19, 2024
Last updated
Jun 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2025

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

Authorized official

Name
Jane Holden
Title
Billing Manager
Phone
(615) 672-7122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

1 Pearl St Ste 2100
Brockton, MA 02301-2868

Mailing address

40 Burton Hills Blvd Ste 370
Nashville, TN 37215-6287
Phone (615) 672-7122

Other practice location 1

60 East St
Methuen, MA 01844-4500
Phone (978) 683-9177

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20241127001349 MA Part B Supplier - Clinic/Group Practice 0749715795 Receives reassigned benefits from 270 practitioners
Practice locations: Methuen, MA; Newburyport, MA; Newton, MA; North Andover, MA; North Easton, MA; Norwood, MA; Raynham, MA; Taunton, MA…
O20260612003984 NH Part B Supplier - Clinic/Group Practice 0749715795 Practice locations: Salem, NH

National Provider Directory

National Provider Directory

Locations

1 Pearl St
Ste 2200
Brockton, MA 02301
Phone (508) 897-6150

2110 Dorchester Ave
Ste 202
Dorchester, MA 02124
Phone (617) 506-2265

2110 Dorchester Ave
Ste 101
Dorchester Center, MA 02124
Phone (617) 506-4709

788 Boston Rd
Groton, MA 01450
Phone (978) 449-0282

60 East St
Methuen, MA 01844
Phone (978) 687-0151

60 East St
Ste 2200
Methuen, MA 01844
Phone (978) 683-9177

511 W Grove St
Ste 201
Middleboro, MA 02346
Phone (508) 947-7600

2007 Bay St
Ste 105
Taunton, MA 02780
Phone (774) 501-3229

Practitioners & affiliated clinicians

Practitioners 302

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 302

NPI Registry JSON

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

{
    "created_epoch": "1726704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749859200000",
    "number": "1336976539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 BURTON HILLS BLVD STE 370",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156287",
            "telephone_number": "615-672-7122",
            "fax_number": "615-672-7849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PEARL ST STE 2100",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023012868",
            "telephone_number": "508-897-6040"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "60 East St",
            "address_purpose": "LOCATION",
            "city": "Methuen",
            "state": "MA",
            "postal_code": "018444500",
            "country_code": "US",
            "telephone_number": "978-683-9177",
            "fax_number": "978-688-8679",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVERE MEDICAL OF MASSACHUSETTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-19",
        "last_updated": "2025-06-14",
        "certification_date": "2025-05-14",
        "status": "A",
        "authorized_official_last_name": "HOLDEN",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "615-672-7122"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jun 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.