NPIMap

Organization Active NPI

Whittier Street Health Center Committee Inc

Doing business as Whittier Street Health Center

  • Clinic/Center
  • Roxbury Crossing, MA
National Provider Identifier
1457397986
Registry record updated Jun 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
4144 Issued in MA
Legal business name
WHITTIER STREET HEALTH CENTER COMMITTEE INC
Doing business as
Whittier Street Health Center
Practice address
1290 Tremont St
Roxbury Crossing, MA 02120-3432
Phone
(617) 427-1000
Fax
(617) 858-2674
NPI assigned
Jun 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2015

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

Authorized official

Name
Mr. Jim Lee
Title
Cfo / Vice President Finance
Phone
(617) 989-3230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 4144 MA Primary

Addresses

Primary practice location

1290 Tremont St
Roxbury Crossing, MA 02120-3432

Mailing address

1290 Tremont St
Roxbury Crossing, MA 02120-3432
Phone (617) 427-1000

Other identifiers 1

IdentifierTypeStateIssuer
1399578MedicaidMA

Other names 1

  • Whittier Street Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110118001290 MA Part A Provider - Federally Qualified Health Center (FQHC) 7911977368 Practice locations: Roxbury, MA

Federally qualified health center certification: CCN 221824

Legal name
WHITTIER STREET HEALTH CENTER COMMITTEE INC
Doing business as
WHITTIER STREET HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 12, 1993
Last certification
Nov 12, 1993
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Sep 15, 1974 in MA
Enrollment address
1290 Tremont St
Roxbury, MA 21203432

National Provider Directory

National Provider Directory
Tax ID family
Whittier Street Health3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

20 Whittier St
Boston, MA 02120
Phone (617) 427-1000

1125 Tremont St
Roxbury Xing, MA 02120
Phone (617) 267-3773

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Aurelia Williams Individual Corporate OfficerBoard Member Nov 1, 2020
Vianka P Belyea Individual Corporate OfficerBoard Member Nov 1, 2010
Gerald Bell Individual Corporate OfficerBoard Member Nov 1, 2010
Eva Clark Individual Corporate OfficerBoard Member Nov 1, 2020
James Lee Individual Corporate OfficerVP of Finance and Cfo May 16, 2005
Corporate DirectorPresident and Ceo Mar 19, 2002 100%
W-2 Managing Employee Dec 30, 2015
Alicia Wedderburn Individual Corporate OfficerBoard Member Nov 1, 2020
Monica Johnson Individual Corporate OfficerBoard Membder Nov 1, 2020
Omolara Bankole Individual Corporate OfficerBoard Member Nov 1, 2010
Frederica M Williams Individual Corporate OfficerVP of Finance and Cfo May 16, 2005
Corporate DirectorPresident and Ceo Mar 19, 2002 100%

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 9

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": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435622400000",
    "number": "1457397986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 TREMONT ST",
            "city": "ROXBURY CROSSING",
            "state": "MA",
            "postal_code": "021203432",
            "telephone_number": "617-427-1000",
            "fax_number": "617-858-2674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 TREMONT ST",
            "city": "ROXBURY CROSSING",
            "state": "MA",
            "postal_code": "021203432",
            "telephone_number": "617-427-1000",
            "fax_number": "617-858-2674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITTIER STREET HEALTH CENTER COMMITTEE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2015-06-30",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "CFO / VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "617-989-3230",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MA",
            "license": "4144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1399578",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Whittier Street Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roxbury Crossing, MA

Sources for this page

Verify at the official NPI Registry.