NPIMap

Organization Active NPI

Expressmed, LLC

  • Urgent Care Clinic/Center
  • Manchester, NH
National Provider Identifier
1407385602
Registry record updated Jun 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
04212 Issued in NH
Legal business name
EXPRESSMED, LLC
Practice address
39 Kosciuszko St
Manchester, NH 03101-1608
Phone
(603) 627-8053
Fax
(603) 627-4241
NPI assigned
Jun 9, 2017
Organization subpart
Yes
Parent organization
EXPRESSMED, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 9, 2017

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

Authorized official

Name
Mr. Nicholas James Vailas
Title
Ceo
Phone
(603) 625-2622

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X 04212 NH Primary

Addresses

Primary practice location

39 Kosciuszko St
Manchester, NH 03101-1608

Mailing address

39 Kosciuszko St
Manchester, NH 03101-1608
Phone (603) 627-8053

Other identifiers 1

IdentifierTypeStateIssuer
3100771MedicaidNH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130213000429 NH Part B Supplier - Clinic/Group Practice 6305090622 Receives reassigned benefits from 23 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Manchester, NH

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Expressmed LLC4 organizations share this tax ID, including this one
Part of
Expressmed LLC

Other organizations with this tax ID 3

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

Locations

39 Kosciuszko St
Manchester, NH 03101
Phone (603) 627-8053

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1496966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496966400000",
    "number": "1407385602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 KOSCIUSZKO ST",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031011608",
            "telephone_number": "603-627-8053",
            "fax_number": "603-627-4241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 KOSCIUSZKO ST",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031011608",
            "telephone_number": "603-627-8053",
            "fax_number": "603-627-4241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPRESSMED, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EXPRESSMED, LLC",
        "enumeration_date": "2017-06-09",
        "last_updated": "2017-06-09",
        "status": "A",
        "authorized_official_last_name": "VAILAS",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "603-625-2622",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NH",
            "license": "04212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3100771",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2017; 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.