Active NPI
Convenientmd LLC
- Urgent Care Clinic/Center
- Pembroke, MA
National Provider Identifier
1457902892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urgent Care Clinic/Center
- Legal business name
- CONVENIENTMD LLC
- Practice address
- 296 Old Oak Street
Pembroke, MA 02359 - Phone
- (339) 244-3033
- NPI assigned
- Sep 26, 2019
- Last updated
- Sep 26, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gareth Dickens
- Title
- Executive Chairman
- Phone
- (603) 501-0863
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urgent Care Clinic/Center | 261QU0200X | Primary |
Addresses
Primary practice location
296 Old Oak Street
Pembroke, MA 02359
Mailing address
111 NH Ave Ste 2
Portsmouth, NH 03801-2864
Phone (603) 410-6700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181115000859 | MA | Part B Supplier - Clinic/Group Practice | 2062667033 |
Receives reassigned benefits from 1 practitioner 15 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Plainville, MA; Weymouth, MA; Westborough, MA; Saugus, MA; Quincy, MA; Pittsfield, MA; Pembroke, MA; Peabody, MA… |
Other NPIs on the same Medicare enrollment 15
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569456000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1569456000000",
"number": "1457902892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 NH AVE STE 2",
"city": "PORTSMOUTH",
"state": "NH",
"postal_code": "038012864",
"telephone_number": "603-410-6700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "296 OLD OAK STREET",
"city": "PEMBROKE",
"state": "MA",
"postal_code": "02359",
"telephone_number": "339-244-3033"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CONVENIENTMD LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-09-26",
"last_updated": "2019-09-26",
"status": "A",
"authorized_official_last_name": "DICKENS",
"authorized_official_first_name": "GARETH",
"authorized_official_title_or_position": "EXECUTIVE CHAIRMAN",
"authorized_official_telephone_number": "603-501-0863"
},
"taxonomies": [
{
"code": "261QU0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Urgent Care",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pembroke, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2019; 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.