NPIMap

Organization Active NPI

Codman Square Health Center Inc

  • Community Health Clinic/Center
  • Dorchester Center, MA
National Provider Identifier
1396808309
Registry record updated Mar 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
CODMAN SQUARE HEALTH CENTER INC
Practice address
637 Washington St
Dorchester Center, MA 02124-3510
Phone
(617) 825-9660
Fax
(617) 288-7898
NPI assigned
Dec 19, 2006
Last updated
Mar 26, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2026

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

Authorized official

Name
Mrs. Guy Fish, CEO
Title
Chief Executive Officer
Phone
(617) 825-9660

Specialties & licenses 1

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

Addresses

Primary practice location

637 Washington St
Dorchester Center, MA 02124-3510

Mailing address

637 Washington St
Dorchester, MA 02124-3510
Phone (617) 825-9660

Other practice location 1

42 Highland Avenue
Randolph, MA 02368-0000
Phone (617) 825-9660

Other practice location 2

9 Peacevale Rd
Dorchester, MA 02124-4417
Phone (617) 822-8744

Other identifiers 2

IdentifierTypeStateIssuer
1211757MedicaidMA
110022129FMedicaidMA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040420000859 MA Part B Supplier - Clinic/Group Practice 8123013869 Receives reassigned benefits from 89 practitioners
Practice locations: Dorchester, MA; Randolph, MA

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

9 Peacevale Rd
Dorchester, MA 02124
Phone (617) 635-1615

Practitioners & affiliated clinicians

Practitioners 97

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 97

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774483200000",
    "number": "1396808309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "637 WASHINGTON ST",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021243510",
            "telephone_number": "617-825-9660",
            "fax_number": "617-288-7898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "637 WASHINGTON ST",
            "city": "DORCHESTER CENTER",
            "state": "MA",
            "postal_code": "021243510",
            "telephone_number": "617-825-9660",
            "fax_number": "617-288-7898"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "42 Highland Avenue",
            "address_purpose": "LOCATION",
            "city": "Randolph",
            "state": "MA",
            "postal_code": "023680000",
            "country_code": "US",
            "telephone_number": "617-825-9660",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9 Peacevale Rd",
            "address_purpose": "LOCATION",
            "city": "Dorchester",
            "state": "MA",
            "postal_code": "021244417",
            "country_code": "US",
            "telephone_number": "617-822-8744",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CODMAN SQUARE HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A",
        "authorized_official_last_name": "FISH",
        "authorized_official_first_name": "GUY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "617-825-9660",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1211757",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110022129F",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dorchester Center, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.