Organization Active NPI

North Brookfield Primary Care

  • Primary Care Clinic/Center
  • North Brookfield, MA
National Provider Identifier
1356132955
Registry record updated May 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
NORTH BROOKFIELD PRIMARY CARE
Practice address
163 N Main St Ste B
North Brookfield, MA 01535-1400
Phone
(508) 380-6366
NPI assigned
May 14, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2025

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

Authorized official

Name
Dr. Laura T. Black, NURSE PRACTITIONERNPI 1295068161
Title
Owner
Phone
(508) 380-6366

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
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

163 N Main St Ste B
North Brookfield, MA 01535-1400

Mailing address

163 N Main St Ste B
North Brookfield, MA 01535-1400
Phone (508) 380-6366

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250724001780 MA Part B Supplier - Clinic/Group Practice 8921515016 Receives reassigned benefits from 4 practitioners
Practice locations: North Brookfield, 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
22D2336181North Brookfield Primary Care163 North Main St, North Brookfield, MA 01535Certificate of waiverDec 25, 2027

National Provider Directory

National Provider Directory

Locations

163 N Main St
Ste B
North Brookfield, MA 01535
Phone (508) 308-6366

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1747180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747180800000",
    "number": "1356132955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 N MAIN ST STE B",
            "city": "NORTH BROOKFIELD",
            "state": "MA",
            "postal_code": "015351400",
            "telephone_number": "508-380-6366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 N MAIN ST STE B",
            "city": "NORTH BROOKFIELD",
            "state": "MA",
            "postal_code": "015351400",
            "telephone_number": "508-380-6366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH BROOKFIELD PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-14",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-380-6366",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Brookfield, MA

Sources for this page

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