NPIMap

Organization Active NPI

Boston Ivf, Inc.

Doing business as The Surgery Center of Waltham

  • Ambulatory Surgical Clinic/Center
  • Waltham, MA
National Provider Identifier
1497831523
Registry record updated Aug 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
4QLZ Issued in MA
Legal business name
BOSTON IVF, INC.
Doing business as
The Surgery Center of Waltham
Practice address
130 2ND Ave
The Surgery Center of Waltham
Waltham, MA 02451-1100
Phone
(781) 434-6400
Fax
(781) 434-6497
NPI assigned
Oct 31, 2006
Last updated
Aug 24, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
BOSTON IVF, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 24, 2009

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

Authorized official

Name
Mr. Derek M. Larkin, JD, MBA
Title
Director of Business
Phone
(781) 434-6500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Fertility Facility 261QA0006X 4QLZ MA
Ambulatory Surgical Clinic/Center 261QA1903X 4QLZ MA Primary

Addresses

Primary practice location

130 2ND Ave
The Surgery Center of Waltham
Waltham, MA 02451-1100

Mailing address

130 2ND Ave
The Surgery Center of Waltham
Waltham, MA 02451-1100
Phone (781) 434-6400

Other identifiers 1

IdentifierTypeStateIssuer
1212524MedicaidMA

Other names 1

  • The Surgery Center of Waltham Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497831523. Details of each certification follow.

Ambulatory surgical center certification: CCN 22C0001033

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
BOSTON IVF, INC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Jul 27, 1999
Last certification
Dec 14, 2017
Ownership / control type
Proprietary
Facility address
130 Second Avenue, 1St Floor
Waltham, MA 02451

National Provider Directory

National Provider Directory
Part of
Boston Ivf

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251072000000",
    "number": "1497831523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 2ND AVE",
            "address_2": "THE SURGERY CENTER OF WALTHAM",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511100",
            "telephone_number": "781-434-6400",
            "fax_number": "781-434-6497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 2ND AVE",
            "address_2": "THE SURGERY CENTER OF WALTHAM",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511100",
            "telephone_number": "781-434-6400",
            "fax_number": "781-434-6497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON IVF, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOSTON IVF, INC.",
        "enumeration_date": "2006-10-31",
        "last_updated": "2009-08-24",
        "status": "A",
        "authorized_official_last_name": "LARKIN",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS",
        "authorized_official_telephone_number": "781-434-6500",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "JD, MBA"
    },
    "taxonomies": [
        {
            "code": "261QA0006X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Fertility Facility",
            "state": "MA",
            "license": "4QLZ",
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MA",
            "license": "4QLZ",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1212524",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Surgery Center of Waltham",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waltham, MA

Sources for this page

Verify at the official NPI Registry.