NPIMap

Organization Active NPI

Charles River Community Health Inc

  • Federally Qualified Health Center (FQHC)
  • Brighton, MA
National Provider Identifier
1487664884
Registry record updated Apr 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
4157 Issued in MA
Legal business name
CHARLES RIVER COMMUNITY HEALTH INC
Practice address
495 Western Ave
Brighton, MA 02135-1007
Phone
(617) 783-0500
Fax
(617) 987-8222
NPI assigned
Aug 8, 2006
Last updated
Apr 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2026

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

Authorized official

Name
Matthew Lockwood Mullaney
Title
Ceo
Phone
(617) 783-0500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 4157 MA Primary

Addresses

Primary practice location

495 Western Ave
Brighton, MA 02135-1007

Mailing address

495 Western Ave
Brighton, MA 02135-1007
Phone (617) 783-0500

Other identifiers 7

IdentifierTypeStateIssuer
686893OtherMATUFTS HEALTH PLAN
1301446MedicaidMA
682536OtherMATUFTS HEALTH PLAN
903699OtherMATUFTS HEALTH PLAN
2227002110OtherMABCBS
W20419OtherMABCBS OPTOMETRY
M12043OtherMABCBS MEDICAL/PODIATRY

Other names 1

  • Joseph M. Smith Community Health Center, Inc Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040820000310 MA Part B Supplier - Clinic/Group Practice 5294709812 Receives reassigned benefits from 43 practitioners
3 other NPIs on this enrollment
Practice locations: Brighton, MA; Waltham, MA
O20090106000405 MA Part A Provider - Federally Qualified Health Center (FQHC) 5294709812 Practice locations: Brighton, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487664884. Details of each certification follow.

Federally qualified health center certification: CCN 221800

Legal name
CHARLES RIVER COMMUNITY HEALTH, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 10, 1970 in MA
Enrollment address
495 Western Ave
Brighton, MA 21351007

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Locations

495 Western Ave
Brighton, MA 02135

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Keplin Allwaters Individual Corporate DirectorBoard Member Vice Clerk Jan 1, 2025
Steven Kent Individual Corporate Director Jan 1, 2017
Modupe Mohammed Individual Corporate DirectorBoard Member Jan 1, 2025
Molly Colwell Individual Corporate DirectorBoard Member Jan 1, 2025
Jacqueline Herrera Individual Corporate DirectorBoard Member Jan 1, 2025
Margaret Kelly Individual Corporate Director Jan 1, 2025
Robert Woodworth Individual Corporate Director Jan 1, 2015
Anne Levine Individual Corporate DirectorBoard Member Jan 1, 2025
Amie Pollack Individual Corporate DirectorBoard Member Jan 1, 2025
Gabriela Canepa Individual Corporate Director Jul 18, 2008
Matthew L Lockwood Mullaney Individual Corporate OfficerCeo Dec 16, 2024 100%
W-2 Managing EmployeeCeo Dec 16, 2024 100%

Practitioners & affiliated clinicians

Practitioners 53

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 53

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776124800000",
    "number": "1487664884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 WESTERN AVE",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021351007",
            "telephone_number": "617-783-0500",
            "fax_number": "617-987-8222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 WESTERN AVE",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021351007",
            "telephone_number": "617-783-0500",
            "fax_number": "617-987-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES RIVER COMMUNITY HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2026-04-14",
        "certification_date": "2026-04-14",
        "status": "A",
        "authorized_official_last_name": "LOCKWOOD MULLANEY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "617-783-0500"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MA",
            "license": "4157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "686893",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1301446",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "682536",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "903699",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2227002110",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OPTOMETRY",
            "identifier": "W20419",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MEDICAL/PODIATRY",
            "identifier": "M12043",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Joseph M. Smith Community Health Center, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Brighton, MA

Sources for this page

Verify at the official NPI Registry.