NPIMap

Organization Active NPI

Roslindale Pediatric Associates, P.C.

  • Pediatrics Physician
  • Boston, MA
National Provider Identifier
1578617445
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
29672 Issued in MA
Legal business name
ROSLINDALE PEDIATRIC ASSOCIATES, P.C.
Practice address
1153 Centre St
31
Boston, MA 02130-3446
Phone
(617) 522-3100
Fax
(617) 522-6366
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Robert D Stacks, M.D.
Title
President
Phone
(617) 522-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 29672 MA Primary

Addresses

Primary practice location

1153 Centre St
31
Boston, MA 02130-3446

Mailing address

1153 Centre St
31
Boston, MA 02130-3446
Phone (617) 522-3100

Other identifiers 5

IdentifierTypeStateIssuer
600454OtherMATUFTS
9757864MedicaidMA
0036005OtherMANEIGHBORHOOD HLTH PLAN
9058OtherMAAETNA US HEALTHCARE
M14816OtherMABLUE CROSS BLUE SHIELD MA

National Provider Directory

National Provider Directory

Locations

1153 Centre St
#31
Boston, MA 02130
Phone (617) 522-3100

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1578617445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1153 CENTRE ST",
            "address_2": "31",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021303446",
            "telephone_number": "617-522-3100",
            "fax_number": "617-522-6366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1153 CENTRE ST",
            "address_2": "31",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021303446",
            "telephone_number": "617-522-3100",
            "fax_number": "617-522-6366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSLINDALE PEDIATRIC ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STACKS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-522-3100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "29672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "600454",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9757864",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HLTH PLAN",
            "identifier": "0036005",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "9058",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MA",
            "identifier": "M14816",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.