NPIMap

Organization Active NPI

Brockton Neighborhood Health Center

  • Federally Qualified Health Center (FQHC)
  • Brockton, MA
National Provider Identifier
1497148407
Registry record updated May 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
4896 Issued in MA
Legal business name
BROCKTON NEIGHBORHOOD HEALTH CENTER
Practice address
158 Pleasant Street
Brockton, MA 02301
Phone
(508) 559-6699
Fax
(508) 559-5073
NPI assigned
Mar 16, 2015
Last updated
May 29, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2018

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

Authorized official

Name
Melvin Benson
Title
Chief Financial Officer
Phone
(508) 559-6699

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 4896 MA Primary

Addresses

Primary practice location

158 Pleasant Street
Brockton, MA 02301

Mailing address

158 Pleasant Street
Brockton, MA 02301
Phone (508) 559-6699

Other identifiers 8

IdentifierTypeStateIssuer
110028118/AMedicaidMA
221830OtherMAMEDICARE PART A
606260OtherMA606260
M18107OtherMABLUE CROSS BLUE SHIELD
000000021197MedicaidMA
M20905OtherMAMEDICARE PART B
0006827OtherMANHP
0192330OtherMAUNITED CARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031230000558 MA Part B Supplier - Clinic/Group Practice 3870491699 Receives reassigned benefits from 127 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brockton, MA

Other NPIs on the same Medicare enrollment 2

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

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
22D2321063Brockton Neighborhood Health Center Vicente's158 Pleasant Street, Brockton, MA 02301Certificate of waiverMar 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
Brockton Neighborhood Health Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1426464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527552000000",
    "number": "1497148407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 PLEASANT STREET",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "02301",
            "telephone_number": "508-559-6699",
            "fax_number": "508-559-5073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 PLEASANT STREET",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "02301",
            "telephone_number": "508-559-6699",
            "fax_number": "508-559-5073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROCKTON NEIGHBORHOOD HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-16",
        "last_updated": "2018-05-29",
        "status": "A",
        "authorized_official_last_name": "BENSON",
        "authorized_official_first_name": "MELVIN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "508-559-6699"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MA",
            "license": "4896",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110028118/A",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART A",
            "identifier": "221830",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "606260",
            "identifier": "606260",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "M18107",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000021197",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "M20905",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NHP",
            "identifier": "0006827",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CARE",
            "identifier": "0192330",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2018; 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.