NPIMap

Organization Active NPI

Square Medical Group LLC

  • Adult Mental Health Clinic/Center
  • Watertown, MA
National Provider Identifier
1356515464
Registry record updated Aug 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
152859 Issued in MA
Legal business name
SQUARE MEDICAL GROUP LLC
Practice address
124 Watertown St
Suite 2D
Watertown, MA 02472-2576
Phone
(617) 916-5069
Fax
(617) 467-4073
NPI assigned
Apr 18, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2015

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

Authorized official

Name
Dr. Natalie Leonid Lender, M.D.NPI 1740371038
Title
Medical Director, Owner
Phone
(617) 916-5069

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 152859 MA Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 152859 MA

Addresses

Primary practice location

124 Watertown St
Suite 2D
Watertown, MA 02472-2576

Mailing address

124 Watertown St
Suite 2D
Watertown, MA 02472-2576
Phone (617) 916-5069

Other identifiers 1

IdentifierTypeStateIssuer
3173615MedicaidMA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100921000924 MA Part B Supplier - Clinic/Group Practice 6608991187 Receives reassigned benefits from 27 practitioners
Practice locations: Newton, MA; Weymouth, MA; Woburn, MA

National Provider Directory

National Provider Directory
Tax ID family
Square Medical Group LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

884 Washington St
Fl Second
East Weymouth, MA 02189

125 Adams St
Fl 3
Newton, MA 02458

275 Hancock St
Bsmt 2
Quincy, MA 02171
Phone (617) 274-7080

124 Watertown St
Ste 2D
Watertown, MA 02472
Phone 6179165069208

884 Washington St
Fl 1
Weymouth, MA 02189
Phone (781) 812-1643

800 W Cummings Park
Ste 1925
Woburn, MA 01801

800 W Cummings Park
Ste 1800
Woburn, MA 01801
Phone 6179165069201

Practitioners & affiliated clinicians

Practitioners 42

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

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439424000000",
    "number": "1356515464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 WATERTOWN ST",
            "address_2": "SUITE 2D",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024722576",
            "telephone_number": "617-916-5069",
            "fax_number": "617-467-4073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 WATERTOWN ST",
            "address_2": "SUITE 2D",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024722576",
            "telephone_number": "617-916-5069",
            "fax_number": "617-467-4073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SQUARE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-18",
        "last_updated": "2015-08-13",
        "status": "A",
        "authorized_official_last_name": "LENDER",
        "authorized_official_first_name": "NATALIE",
        "authorized_official_middle_name": "LEONID",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR, OWNER",
        "authorized_official_telephone_number": "617-916-5069",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MA",
            "license": "152859",
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "MA",
            "license": "152859",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3173615",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2015; 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.