NPIMap

Organization Active NPI

Manet Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Quincy, MA
National Provider Identifier
1376574103
Registry record updated Mar 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
4801 Issued in MA
Legal business name
MANET COMMUNITY HEALTH CENTER, INC.
Practice address
1193 Sea St
Quincy, MA 02169-3544
Phone
(617) 471-8683
Fax
(617) 773-1625
NPI assigned
Jul 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2023

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

Authorized official

Name
Cynthia Sierra
Title
Chief Executive Officer
Phone
(617) 404-4101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 4801 MA Primary

Addresses

Primary practice location

1193 Sea St
Quincy, MA 02169-3544

Mailing address

110 W Squantum St
North Quincy, MA 02171-2122
Phone (617) 376-3030

Other identifiers 1

IdentifierTypeStateIssuer
1302841MedicaidMA

Other names 1

  • Manet Community Health Center, Inc. at Houghs Neck Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060815000241 MA Part A Provider - Federally Qualified Health Center (FQHC) 4486555158 Practice locations: Quincy, MA

Federally qualified health center certification: CCN 221839

Legal name
MANET COMMUNITY HEALTH CENTER, INC.
Doing business as
MANET COMMUNITY HEALTH CENTER AT HOUGH'S NECK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 1, 1992
Last certification
Aug 1, 1992
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 5, 1978 in MA
Enrollment address
1193 Sea St
Quincy, MA 21693544

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Manet Community Health Center Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

110 W Squantum St
Quincy, MA 02171
Phone (617) 376-3000

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Cynthia Sierra Individual Corporate OfficerChief Executive Officer Jan 1, 2016 100%
Operational/Managerial ControlChief Executive Officer Jan 1, 2016 100%
Samantha Chen Individual Corporate DirectorBoard Member Jan 15, 2019
Zachary Eaton Individual Corporate DirectorBoard Member Jan 16, 2018 75%
Neda Hovaizi Individual Corporate DirectorBoard Member Jan 15, 2019
Lawrence Flanagan Individual Corporate DirectorBoard Member Feb 21, 2017
Stephen Keches Individual Corporate Director Jan 16, 2018
John D Brothers Individual Corporate DirectorBoard Member Oct 14, 2010
Joseph M Reardon Individual Corporate Director Oct 14, 2010
Robert Griffin Individual Corporate DirectorBoard Member Jan 24, 2011
Lavinia M Roosa Individual W-2 Managing EmployeeDirector of Revenue Mar 5, 2001
Jane Kisielius Individual Corporate DirectorBoard Member Dec 17, 2017
Grace McAuliffe Individual Corporate DirectorBoard Member Dec 17, 2017 75%
Anita Christie Individual Corporate DirectorBoard Member Mar 20, 2023 75%
Ivan S Wong Individual Corporate Director Oct 14, 2010
Linda a Kelly Individual Corporate DirectorBoard Member Oct 14, 2010
Karen Ward Individual Corporate DirectorBoard Member Mar 20, 2023 75%
Roberto Costa Individual Corporate DirectorBoard Member Mar 20, 2023 75%
Nancy Wyrebek Individual Corporate DirectorBoard Member Mar 20, 2023 75%
Anne Bisson Individual Corporate DirectorBoard Member Nov 15, 2016

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677801600000",
    "number": "1376574103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 W SQUANTUM ST",
            "city": "NORTH QUINCY",
            "state": "MA",
            "postal_code": "021712122",
            "telephone_number": "617-376-3030",
            "fax_number": "617-774-1906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1193 SEA ST",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021693544",
            "telephone_number": "617-471-8683",
            "fax_number": "617-773-1625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANET COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "status": "A",
        "authorized_official_last_name": "SIERRA",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "617-404-4101"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MA",
            "license": "4801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1302841",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Manet Community Health Center, Inc. at Houghs Neck",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Manet Community Health Center, Inc. at Houghs Neck",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Quincy, MA

Sources for this page

Verify at the official NPI Registry.