NPIMap

Organization Active NPI

Brain Analysis & Neurodevelopment Center, LLC

Doing business as Concussion Center of Massachusetts

  • Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
  • Hadley, MA
National Provider Identifier
1386008985
Registry record updated Jan 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Brain Injury Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P0301X
License
7324 Issued in MA
Legal business name
BRAIN ANALYSIS & NEURODEVELOPMENT CENTER, LLC
Doing business as
Concussion Center of Massachusetts
Practice address
195 Russell St
Suite B-13
Hadley, MA 01035-9515
Phone
(413) 203-6600
Fax
(866) 651-1899
NPI assigned
Apr 9, 2016
Last updated
Jan 10, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2017

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

Authorized official

Name
Robert Davis, PSYDNPI 1497033997
Title
Executive Director
Phone
(413) 203-6600

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
Brain Injury Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P0301X 7324 MA Primary

Addresses

Primary practice location

195 Russell St
Suite B-13
Hadley, MA 01035-9515

Mailing address

195 Russell St
Suite B-13
Hadley, MA 01035-9515
Phone (413) 203-6600

Other names 1

  • Concussion Center of Massachusetts Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Brain Analysis and Neurodevelopment Center 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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1460160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484006400000",
    "number": "1386008985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 RUSSELL ST",
            "address_2": "SUITE B-13",
            "city": "HADLEY",
            "state": "MA",
            "postal_code": "010359515",
            "telephone_number": "413-203-6600",
            "fax_number": "866-651-1899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 RUSSELL ST",
            "address_2": "SUITE B-13",
            "city": "HADLEY",
            "state": "MA",
            "postal_code": "010359515",
            "telephone_number": "413-203-6600",
            "fax_number": "866-651-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAIN ANALYSIS & NEURODEVELOPMENT CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-09",
        "last_updated": "2017-01-10",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "413-203-6600",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "2081P0301X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Brain Injury Medicine",
            "state": "MA",
            "license": "7324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Concussion Center of Massachusetts",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hadley, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2017; 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.