NPIMap

Organization Active NPI

Crown Colony Pediatrics PC

  • Pediatrics Physician
  • Quincy, MA
National Provider Identifier
1477591469
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CROWN COLONY PEDIATRICS PC
Practice address
500 Congress St
Suite 1F
Quincy, MA 02169-0908
Phone
(617) 471-3411
NPI assigned
Jun 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Leslie Ronnie Blachman, M.D.NPI 1669435590
Title
President
Phone
(617) 471-3411

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

500 Congress St
Suite 1F
Quincy, MA 02169-0908

Mailing address

500 Congress St
Suite 1F
Quincy, MA 02169-0908
Phone (617) 471-3411

Other identifiers 1

IdentifierTypeStateIssuer
9782362MedicaidMA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D0078133Crown Colony Pediatrics500 Congress Street, Suite 1F, Quincy, MA 02169ComplianceMay 19, 2028

National Provider Directory

National Provider Directory

Locations

500 Congress St
Ste 1F
Quincy, MA 02169
Phone (617) 471-3411

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": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477591469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 CONGRESS ST",
            "address_2": "SUITE 1F",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021690908",
            "telephone_number": "617-471-3411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 CONGRESS ST",
            "address_2": "SUITE 1F",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021690908",
            "telephone_number": "617-471-3411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROWN COLONY PEDIATRICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLACHMAN",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "RONNIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-471-3411",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9782362",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.