NPIMap

Organization Active NPI

Specialty Ic Mass LLC

  • Infusion Therapy Clinic/Center
  • Braintree, MA
National Provider Identifier
1346713708
Registry record updated Feb 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X
Legal business name
SPECIALTY IC MASS LLC
Practice address
30 Braintree Hill Office Park Ste 103
Braintree, MA 02184-8751
Phone
(212) 776-9090
Fax
(800) 540-1852
NPI assigned
Jan 9, 2019
Last updated
Feb 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2024

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

Authorized official

Name
Sue Rottura
Title
Director
Phone
(561) 323-8987

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Infusion Therapy Clinic/Center 261QI0500X NU Primary
Obesity Medicine (Family Medicine) Physician 207QB0002X NU

Addresses

Primary practice location

30 Braintree Hill Office Park Ste 103
Braintree, MA 02184-8751

Mailing address

1047 Surf Ave Ste 2
Brooklyn, NY 11224-2810
Phone (212) 776-9090

Other practice location 1

444 Washington St Ste 405
Woburn, MA 01801-1072
Phone (212) 776-9090

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230426001234 MA Part B Supplier - Clinic/Group Practice 2062877046 Receives reassigned benefits from 3 practitioners
Practice locations: Braintree, MA; Woburn, MA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D2277728Specialty Ic Mass, LLC30 Braintree Hill, Braintree, MA 02184Certificate of waiverMar 2, 2027
22D2277729Specialty Ic Mass LLC444 Washington Street Suite 405, Woburn, MA 01801Certificate of waiverMar 2, 2027

National Provider Directory

National Provider Directory

Locations

30 Braintree Hill Office Park
Ste 103
Braintree, MA 02184

195 Main St
Groton, MA 01450

444 Washington St
Ste 405
Woburn, MA 01801

1047 Surf Ave
Ste 2
Brooklyn, NY 11224

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1546992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707091200000",
    "number": "1346713708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1047 SURF AVE STE 2",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112242810",
            "telephone_number": "212-776-9090",
            "fax_number": "800-540-1852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 BRAINTREE HILL OFFICE PARK STE 103",
            "city": "BRAINTREE",
            "state": "MA",
            "postal_code": "021848751",
            "telephone_number": "212-776-9090",
            "fax_number": "800-540-1852"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "444 Washington St Ste 405",
            "address_purpose": "LOCATION",
            "city": "Woburn",
            "state": "MA",
            "postal_code": "018011072",
            "country_code": "US",
            "telephone_number": "212-776-9090",
            "fax_number": "800-540-1852",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPECIALTY IC MASS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-09",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A",
        "authorized_official_last_name": "ROTTURA",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "561-323-8987"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207QB0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Obesity Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Braintree, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; 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.