NPIMap

Organization Active NPI

Brockton Visiting Nurse Association

  • Community Based Hospice Care Agency
  • Brockton, MA
National Provider Identifier
1528528205
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
BROCKTON VISITING NURSE ASSOCIATION
Practice address
500 Belmont Street
Suite 200
Brockton, MA 02301
Phone
(508) 894-5256
Fax
(508) 894-5290
NPI assigned
Mar 20, 2019
Last updated
Jul 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Authorized official

Name
Erika Hamilton
Title
VP Finance
Phone
(508) 894-5256

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU
Community Based Hospice Care Agency 251G00000X NU Primary

Addresses

Primary practice location

500 Belmont Street
Suite 200
Brockton, MA 02301

Mailing address

500 Belmont Street
Suite 200
Brockton, MA 02301
Phone (508) 894-5256

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190427000074 MA Part A Provider - Hospice 7517094303 Practice locations: Brockton, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1528528205. Details of each certification follow.

Hospice certification: CCN 221608

Legal name
BROCKTON VISITING NURSE ASSOCIATION
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jul 15, 2019
Last certification
Jul 15, 2019
Ownership / control type
Other
Organization structure
CorporationNon-profit
Enrollment address
500 Belmont St
Ste 200
Brockton, MA 02301-4985

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Brockton Visiting Nurse AssociationCCN 221608 · All quality measures
Ownership
Other
Certified
Jul 15, 2019
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Brockton Visiting Nurse Association2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

500 Belmont St
Brockton, MA 02301
Phone (508) 587-2121

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Jean-Ellen Ouellette-Kenney Individual Corporate DirectorBoard of Directors May 1, 2022
Gail E Russell Individual Corporate DirectorChairman Board of Directors May 1, 2016
Samantha Sousa Individual Corporate DirectorBoard of Directors May 1, 2023
Ashley Dibiase Individual Corporate DirectorClerk Board of Directors May 1, 2024
Christopher Joncas Individual Contracted Managing EmployeeMD; Oct 1, 2025
Thomas Samaras Individual Corporate DirectorBoard of Directors Oct 1, 2022
Maria O Johnson Individual Corporate OfficerVice President of Finance May 19, 2025
W-2 Managing EmployeeDirector of Finance Oct 21, 2025
Loren Victor Individual Corporate DirectorBod Feb 1, 2025
Michael J Lyons Individual Corporate OfficerCeo and President Apr 7, 2025
W-2 Managing EmployeeAd; Apr 7, 2025
Drew Fisk Individual Corporate DirectorBoard of Directors May 1, 2025
Margaret E Mone Individual Corporate DirectorTreasurer Board of Directors May 1, 2017
Nishwanda Ellis Individual Corporate DirectorBoard of Directors May 1, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 9

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1553040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688947200000",
    "number": "1528528205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 BELMONT STREET",
            "address_2": "SUITE 200",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "02301",
            "telephone_number": "508-894-5256",
            "fax_number": "508-894-5290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 BELMONT STREET",
            "address_2": "SUITE 200",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "02301",
            "telephone_number": "508-894-5256",
            "fax_number": "508-894-5290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROCKTON VISITING NURSE ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-20",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "ERIKA",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "508-894-5256"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.