Edward M. Kennedy Community Health Center, Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

4039 Issued in MA

Legal business name

EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC

Practice address

72 Union Ave
Framingham, MA 01702-8216

Phone

(508) 270-5700

Fax

(508) 370-3637

NPI assigned

Jul 13, 2009

Last updated

Jan 31, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INCAs reported in NPPES

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

Authorized official

Name

Mr. Stephen J Kerrigan

Title

President & Ceo

Phone

(508) 854-2122

Specialties & licenses 3

Addresses

Other names 1

• Great Brook Valley Health Center, Inc Former legal business name

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 1497984363. Details of each certification follow.

• CCN 221912 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 221912

Legal name

EDWARD M KENNEDY COMMUNITY HEALTH CENTER, INC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jul 17, 2012

Last certification

Jul 17, 2012

Ownership / control type

For profit – corporation

Facility address

72 Union Avenue
Framingham, MA 01702

Part of

Great Brook Valley HLTH

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

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1497984363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 NE CUTOFF STE 200",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016061224",
            "telephone_number": "508-854-2122",
            "fax_number": "508-853-8593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 UNION AVE",
            "city": "FRAMINGHAM",
            "state": "MA",
            "postal_code": "017028216",
            "telephone_number": "508-270-5700",
            "fax_number": "508-370-3637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC",
        "enumeration_date": "2009-07-13",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A",
        "authorized_official_last_name": "KERRIGAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "508-854-2122",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MA",
            "license": "4039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Brook Valley Health Center, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Great Brook Valley Health Center, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Courtney Llewellyn Edman, M.S., PT
• Edmon Y Jacobson MD PC
• Edward M Kennedy Community Health Center
• Edward M. Kennedy Community Health Center, Inc
• Edward M. Kennedy Community Health Center, Inc
• Edward M. Kennedy Community Health Center, Inc
• Andrew Cooper Edwards
• Jodi Edwards
• Ojonye Chris Ega
• Derrick Egbert

• Federally Qualified Health Center (FQHC) in Framingham, MA
• Providers in Framingham, MA by specialty
• Federally Qualified Health Center (FQHC) in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.