NPIMap

Organization Active NPI

Fallon Community Health Plan

  • PACE Provider Organization
  • Worcester, MA
National Provider Identifier
1376696674
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PACE Provider OrganizationTaxonomy code 251T00000X
License
1803247 Issued in MA
Legal business name
FALLON COMMUNITY HEALTH PLAN
Practice address
277 E Mountain St
Worcester, MA 01606-1207
Phone
(508) 852-2026
Fax
(508) 856-7130
NPI assigned
Jan 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Charles Goheen
Title
Chief Financial Officer
Phone
(508) 368-9499

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X 1803247 MA Primary

Addresses

Primary practice location

277 E Mountain St
Worcester, MA 01606-1207

Mailing address

10 Chestnut St
Worcester, MA 01608-2898
Phone (508) 368-9437

Other identifiers 1

IdentifierTypeStateIssuer
1803247MedicaidMA

Other names 1

  • Summit ElderCareSM Other name

National Provider Directory

National Provider Directory

Locations

277 E Mountain St
Worcester, MA 01606
Phone (508) 852-2026

Practitioners & affiliated clinicians

Practitioners 8

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": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376696674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 CHESTNUT ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016082898",
            "telephone_number": "508-368-9437",
            "fax_number": "508-754-1931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 E MOUNTAIN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016061207",
            "telephone_number": "508-852-2026",
            "fax_number": "508-856-7130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALLON COMMUNITY HEALTH PLAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GOHEEN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "508-368-9499",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "MA",
            "license": "1803247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1803247",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit ElderCareSM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.