NPIMap

Organization Active NPI

Middlesex Recovery Professional Corporation

  • Addiction Medicine (Family Medicine) Physician
  • Woburn, MA
National Provider Identifier
1487971461
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
Legal business name
MIDDLESEX RECOVERY PROFESSIONAL CORPORATION
Practice address
20 Tower Office Park
Woburn, MA 01801-2113
Phone
(781) 305-3887
NPI assigned
Apr 29, 2010
Last updated
Jul 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

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

Authorized official

Name
Bruce Jarvie
Title
VP, Treasurer
Phone
(214) 379-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) Physician 207QA0401X NU Primary

Addresses

Primary practice location

20 Tower Office Park
Woburn, MA 01801-2113

Mailing address

20 Tower Office Park
Woburn, MA 01801-2113
Phone (781) 305-3887

Other practice location 1

2 Courthouse Ln Unit 2
Chelmsford, MA 01824-1743
Phone (978) 455-0807

Other practice location 2

61 Prospect St
Gloucester, MA 01930-5929
Phone (978) 515-7664

Other practice location 3

966 Park St Ste B3
Stoughton, MA 02072-3650
Phone (781) 436-3670

Other practice location 4

45 Stiles Rd
Salem, NH 03079-4808
Phone (603) 824-6937

Other practice location 5

85 E Main St
Norton, MA 02766-2307
Phone (508) 285-8550

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120228000270 MA Part B Supplier - Clinic/Group Practice 5698933216 Receives reassigned benefits from 12 practitioners
Practice locations: Chelmsford, MA; Gloucester, MA; Norton, MA; Stoughton, MA; Woburn, MA

Other NPIs with the same Medicare PAC ID 1

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

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
22D2117019Middlesex Recovery PC2 Courthouse Lane #2, Chelmsford, MA 01824Certificate of waiverAug 7, 2026
22D2152022Middlesex Recovery, PC966 Park St, Unit B-3, Stoughton, MA 02072Certificate of waiverJul 31, 2026
22D2159945Middlesex Recovery PC61 Prospect St, Gloucester, MA 01930Certificate of waiverJan 1, 2027
22D2238786Middlesex Recovery, PC85 East Main Street, Norton, MA 02766Certificate of waiverOct 5, 2027

National Provider Directory

National Provider Directory

Locations

85 E Main St
Norton, MA 02766
Phone (508) 285-8550

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1272499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1487971461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 TOWER OFFICE PARK",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018012113",
            "telephone_number": "781-305-3887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 TOWER OFFICE PARK",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018012113",
            "telephone_number": "781-305-3887"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Courthouse Ln Unit 2",
            "address_purpose": "LOCATION",
            "city": "Chelmsford",
            "state": "MA",
            "postal_code": "018241743",
            "country_code": "US",
            "telephone_number": "978-455-0807",
            "fax_number": "978-455-2935",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "61 Prospect St",
            "address_purpose": "LOCATION",
            "city": "Gloucester",
            "state": "MA",
            "postal_code": "019305929",
            "country_code": "US",
            "telephone_number": "978-515-7664",
            "fax_number": "978-865-3689",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "966 Park St Ste B3",
            "address_purpose": "LOCATION",
            "city": "Stoughton",
            "state": "MA",
            "postal_code": "020723650",
            "country_code": "US",
            "telephone_number": "781-436-3670",
            "fax_number": "781-436-3683",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "45 Stiles Rd",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "NH",
            "postal_code": "030794808",
            "country_code": "US",
            "telephone_number": "603-824-6937",
            "fax_number": "603-824-6939",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "85 E Main St",
            "address_purpose": "LOCATION",
            "city": "Norton",
            "state": "MA",
            "postal_code": "027662307",
            "country_code": "US",
            "telephone_number": "508-285-8550",
            "fax_number": "774-430-4210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MIDDLESEX RECOVERY PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-29",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A",
        "authorized_official_last_name": "JARVIE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "VP, TREASURER",
        "authorized_official_telephone_number": "214-379-3300"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woburn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.