NPIMap

Organization Active NPI

The Outreach Wellness Center LLC

  • Social Worker
  • Quincy, MA
National Provider Identifier
1346009453
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Legal business name
THE OUTREACH WELLNESS CENTER LLC
Practice address
1354 Hancock St Ste 205
Quincy, MA 02169-5109
Phone
(857) 939-4445
NPI assigned
Mar 19, 2024
Last updated
Mar 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Authorized official

Name
Mr. Brandon Gholson, LCSWNPI 1639420011
Title
Intake Coordinator
Phone
(857) 939-4445

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
Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 104100000X Primary

Addresses

Primary practice location

1354 Hancock St Ste 205
Quincy, MA 02169-5109

Mailing address

200 Newbury Ave Apt 1
Quincy, MA 02171-2259

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240813001970 MA Part B Supplier - Clinic/Group Practice 3577001288 Receives reassigned benefits from 1 practitioner
Practice locations: Quincy, MA

National Provider Directory

National Provider Directory

Locations

1354 Hancock St
Ste 205
Quincy, MA 02169
Phone (857) 939-4445

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1346009453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NEWBURY AVE APT 1",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021712259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1354 HANCOCK ST STE 205",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021695109",
            "telephone_number": "857-939-4445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE OUTREACH WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "GHOLSON",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "INTAKE COORDINATOR",
        "authorized_official_telephone_number": "857-939-4445",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.