NPIMap

Individual provider Active NPI

Martha G Charley, FNP

  • Family Nurse Practitioner
  • Sturbridge, MA
National Provider Identifier
1609368919
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN213217 Issued in MA
Practice address
Southbridge Pain Clinic
48 Main Street Suite 6
Sturbridge, MA 01566
Phone
(508) 347-9111
NPI assigned
Jun 1, 2018
Last updated
Dec 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN01800 RI
Family Nurse Practitioner 363LF0000X RN213217 MA Primary

Addresses

Primary practice location

Southbridge Pain Clinic
48 Main Street Suite 6
Sturbridge, MA 01566

Mailing address

637 Washington St
Dorchester, MA 02124-3510
Phone (617) 825-9660

Other practice location 1

637 Washington St
Dorchester, MA 02124-3510
Phone (617) 825-9660

Other identifiers 1

IdentifierTypeStateIssuer
110197544AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, MA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20181003001487 RI Practitioner - Nurse Practitioner 2961754940 Reassigns benefits to 1 organization
I20230414000811 MA Practitioner - Nurse Practitioner 2961754940

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

637 Washington St
Dorchester, MA 02124-3510

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN01800RIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Codman Square Health Center Inc CurrentSince Apr 4, 2023 Accepting new patients
Trucare Inc CurrentSince Aug 18, 2018 Accepting new patients
Southbridge Interventional Pain,Inc PastSince May 14, 2023 Accepting new patients

Locations

637 Washington St
Dorchestr Ctr, MA 02124
Phone (617) 822-8211

725 Reservoir Ave
Ste 103
Cranston, RI 02910
Phone (401) 829-4446

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JJGGCA
  • Direct secure messaging: mcharley90436@direct.bmc.masshiway.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1527811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1609368919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "637 WASHINGTON ST",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021243510",
            "telephone_number": "617-825-9660",
            "fax_number": "617-288-7898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SOUTHBRIDGE PAIN CLINIC",
            "address_2": "48 MAIN STREET SUITE 6",
            "city": "STURBRIDGE",
            "state": "MA",
            "postal_code": "01566",
            "telephone_number": "508-347-9111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "637 Washington St",
            "address_purpose": "LOCATION",
            "city": "Dorchester",
            "state": "MA",
            "postal_code": "021243510",
            "country_code": "US",
            "telephone_number": "617-825-9660",
            "fax_number": "617-288-7898",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHARLEY",
        "first_name": "MARTHA",
        "middle_name": "G",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-01",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "RI",
            "license": "APRN01800",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN213217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110197544A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sturbridge, MA

Sources for this page

Verify at the official NPI Registry.