Western New England University

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

WESTERN NEW ENGLAND UNIVERSITY

Doing business as

Western New England University Sports Medicine

Practice address

1215 Wilbraham Rd
Springfield, MA 01119-2612

Phone

(413) 782-1202

Fax

(972) 367-3451

NPI assigned

Oct 27, 2015

Organization subpart

No

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

Authorized official

Name

Mouzon Bass III

Title

Agent

Phone

(972) 367-4845

Specialties & licenses 2

Addresses

Other names 1

• Western New England University Sports Medicine Doing business as

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

CLIA laboratory certificates

Tax ID family

Western New England University2 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.

• Western New England University

  • Adult Health Nurse Practitioner
  • Springfield, MA
  • NPI 1740740737
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Western New England University

  • Adult Health Nurse Practitioner
  • Springfield, MA
  • NPI 1740740737
  NPPES parent name

Practitioners 4

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

• Lauren Dansereau, NP

  • Adult Health Nurse Practitioner
  • Springfield, MA
  • NPI 1427078294
  NPD (past)
• Mark A Dutille, PA-C

  • Physician Assistant
  • Springfield, MA
  • NPI 1447268149
  NPD (past)
• Tracy Ann Midwood

  • Athletic Trainer
  • Springfield, MA
  • NPI 1891281226
  NPD (past)
• Michael A Vallee, MS, L-ATC

  • Athletic Trainer
  • Springfield, MA
  • NPI 1356378970
  NPD (past)

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

{
    "created_epoch": "1445904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445904000000",
    "number": "1356713572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 650850",
            "address_2": "DEPT 1011",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752650850",
            "telephone_number": "972-367-4845",
            "fax_number": "972-367-3452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 WILBRAHAM RD",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011192612",
            "telephone_number": "413-782-1202",
            "fax_number": "972-367-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN NEW ENGLAND UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-27",
        "last_updated": "2015-10-27",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "MOUZON",
        "authorized_official_title_or_position": "AGENT",
        "authorized_official_telephone_number": "972-367-4845",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western New England University Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Western Massachusetts Gastroenterology Assoc, PC
• Western Massachusetts Lifecare Corporation, Inc (Reeds Landing)
• Western Massachusetts Primary Care PC
• Western New England Medical Transport LLC
• Western New England Renal and Transplant Associates, P.C.
• Western New England University
• Amanda A. Westlake, M.D.
• Tasha Weston-Senior, LCSW
• Erica Weston, MD
• Jessica Lynne Wetmore

• Internal Medicine Physician in Springfield, MA
• Providers in Springfield, MA by specialty
• Internal Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.