NPIMap

Organization Active NPI

T Massachusetts, LLC

  • Psychiatric Hospital
  • Worcester, MA
National Provider Identifier
1346728748
Registry record updated Jun 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
T MASSACHUSETTS, LLC
Practice address
100 Century Dr
Worcester, MA 01606
Phone
(774) 366-7000
Fax
(774) 701-0950
NPI assigned
Jul 30, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2021

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

Authorized official

Name
Richard A Kresch, M.D.
Title
Manager
Phone
(212) 243-5565

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

100 Century Dr
Worcester, MA 01606

Mailing address

100 Century Drive
Worcester, MA 01606
Phone (774) 366-7000

Other identifiers 1

IdentifierTypeStateIssuer
110150798MedicaidMA

Other names 1

  • Hospital for Behavioral Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20181018002000 MA Part A Provider - Hospital 6901159003 Practice locations: Worcester, MA
O20190123000592 MA Part B Supplier - Clinic/Group Practice 6901159003 Receives reassigned benefits from 26 practitioners
Practice locations: Worcester, MA
O20210816002805 NY Part B Supplier - Clinic/Group Practice 6901159003 Receives reassigned benefits from 1 practitioner
Practice locations: Syracuse, NY

Hospital certification: CCN 224045

Legal name
T MASSACHUSETTS, LLC
Doing business as
HOSPITAL FOR BEHAVIORAL MEDICINE
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Mar 22, 2019
Last certification
Mar 22, 2019
Beds
82
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Jul 25, 2018 in DE
Enrollment address
100 Century Dr
Worcester, MA 16061244
Main/Primary Hospital Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Hospital for Behavioral MedicineCCN 224045
Type
Psychiatric
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Richard a Kresch Individual Corporate OfficerManager Jan 14, 2019
W-2 Managing EmployeeManager Jan 14, 2019
James Cha Individual Corporate DirectorBoard Member Jan 14, 2019
Umass Memorial Health Ventures, Inc. Organization, Worcester, MA Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jan 14, 2019 33%
Lola Development Organization, New York, NY LLC, For-profit 5% Or Greater Indirect Ownership Interest Jan 14, 2019 67%
Worcester Behavioral Innovations LLC Organization, New York, NY LLC, For-profit 5% Or Greater Direct Ownership Interest Jan 14, 2019 100%

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1532908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624579200000",
    "number": "1346728748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CENTURY DRIVE",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "01606",
            "telephone_number": "774-366-7000",
            "fax_number": "774-701-0950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CENTURY DR",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "01606",
            "telephone_number": "774-366-7000",
            "fax_number": "774-701-0950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "T MASSACHUSETTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-30",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A",
        "authorized_official_last_name": "KRESCH",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "212-243-5565",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110150798",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospital for Behavioral Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.