NPIMap

Organization Active NPI

Boston Medical Center Corporation

Doing business as Greater Roslindale Medical and Dental Center

  • Community Health Clinic/Center
  • Roslindale, MA
National Provider Identifier
1386718823
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
V112 Issued in MA
Legal business name
BOSTON MEDICAL CENTER CORPORATION
Doing business as
Greater Roslindale Medical and Dental Center
Practice address
4199 Washington St
Roslindale, MA 02131-1733
Phone
(617) 323-4440
Fax
(617) 323-7870
NPI assigned
Nov 17, 2006
Last updated
Jul 12, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
BOSTON MEDICAL CENTER CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Authorized official

Name
Teresa T Newsom
Title
SVP, Cfo
Phone
(617) 414-2693

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X V112 MA Primary

Addresses

Primary practice location

4199 Washington St
Roslindale, MA 02131-1733

Mailing address

4199 Washington St
Roslindale, MA 02131-1733
Phone (617) 323-4440

Other identifiers 1

IdentifierTypeStateIssuer
1212095MedicaidMA

Other names 1

  • Greater Roslindale Medical and Dental Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050531000034 MA Part B Supplier - Clinic/Group Practice 0547222051 Receives reassigned benefits from 40 practitioners
1 other NPI on this enrollment
Practice locations: Roslindale, MA
O20071219000041 MA Part A Provider - Hospital 0547222051 7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386718823. Details of each certification follow.

Hospital certification: CCN 220031

Legal name
BOSTON MEDICAL CENTER CORPORATION
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Mar 28, 2019
Beds
441
Ownership / control type
Private (not for profit)
Most recent change of ownership
Jul 1, 1996 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Jun 14, 1996 in MA
Enrollment address
1 Boston Medical Ctr PL
Boston, MA 21182908
Other Hospital Practice Location
Hospital subgroups
Acute care, Other

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).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Boston Medical CenterCCN 220031 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Boston Emergency Services Team Bay Cove Ucc

Locations

6 Cummins Hwy
Roslindale, MA 02131
Phone (617) 323-4440

Ownership & related parties

All disclosed owners & managing parties 30

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

NameRoleSinceShare
William Halpin Individual Corporate Director Feb 12, 1998
Karen Kames Individual Corporate OfficerBoard of Directors Aug 1, 2016
Teresa T Newsom Individual Corporate OfficerSVP Finance & Cfo Aug 1, 2020
Corporate DirectorSVP Finance & Cfo Aug 1, 2020
W-2 Managing EmployeeSVP Finance & Cfo Aug 1, 2020
Azra Kanji Individual Corporate OfficerBoard of Directors Aug 1, 2016
James Blue Individual Corporate OfficerBoard of Directors Aug 1, 2016
Ruth Ellen Fitch Individual Corporate OfficerBoard of Directors Aug 1, 2016
Richard Marks Individual Corporate OfficerBoard of Directors Aug 1, 2016
Anthony Hollenberg Individual Corporate OfficerPresident Apr 3, 2023
Corporate DirectorPresident Apr 3, 2023
Claire Perlman Individual Corporate OfficerBoard of Directors Aug 1, 2016
Pierre Cremieux Individual Corporate OfficerBoard of Directors Aug 1, 2016
Nicole Sexton Individual W-2 Managing Employee Jun 1, 2019
Brendan G Magauran Individual Corporate OfficerBoard of Directors Aug 1, 2016
Barry Bock Individual Corporate OfficerBoard of Directors Aug 1, 2016
Randi Cutler Individual Corporate OfficerBoard of Directors Aug 1, 2016
Martha Samuelson Individual Corporate OfficerBoard of Directors Aug 1, 2016
Monica Valdes Lupi Individual Corporate OfficerBoard of Directors Aug 1, 2016
BMC Health System Inc Organization, Boston, MA Non-profit Other Jul 1, 2013
David Beck Individual Corporate Officer Dec 31, 2011
Paul Egerman Individual Corporate OfficerBoard of Directors Aug 1, 2016
David Ament Individual Corporate OfficerBoard of Directors Aug 1, 2016
Yousef Ghanem Individual W-2 Managing EmployeeVice President Finance May 31, 2022
Andrew Youniss Individual Corporate OfficerBoard of Directors Aug 1, 2016
Sandra Cotterell Individual Corporate Director Mar 7, 1994
Jerod Mayo Individual Corporate OfficerBoard of Directors Aug 1, 2016
Karen Antman Individual Corporate OfficerBoard of Directors Aug 1, 2016
Karen Fine Individual W-2 Managing EmployeeController May 17, 2023
David L Coleman Individual Corporate OfficerBoard of Directors Aug 1, 2016
Melanie Foley Individual Corporate OfficerBoard of Directors Aug 1, 2016
Anita Bekestein Individual Corporate OfficerBoard of Directors Aug 1, 2016
John Hailer Individual Corporate OfficerBoard of Directors Aug 1, 2016

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 47

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.

View all 47

Affiliated clinicians 1,719

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,719

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1386718823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4199 WASHINGTON ST",
            "city": "ROSLINDALE",
            "state": "MA",
            "postal_code": "021311733",
            "telephone_number": "617-323-4440",
            "fax_number": "617-323-7870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4199 WASHINGTON ST",
            "city": "ROSLINDALE",
            "state": "MA",
            "postal_code": "021311733",
            "telephone_number": "617-323-4440",
            "fax_number": "617-323-7870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON MEDICAL CENTER CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOSTON MEDICAL CENTER CORPORATION",
        "enumeration_date": "2006-11-17",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "NEWSOM",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "SVP, CFO",
        "authorized_official_telephone_number": "617-414-2693"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "MA",
            "license": "V112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1212095",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greater Roslindale Medical and Dental Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Greater Roslindale Medical and Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roslindale, MA

Sources for this page

Verify at the official NPI Registry.