NPIMap

Organization Active NPI

Webster Square Medical Center, Inc

  • Internal Medicine Physician
  • Worcester, MA
National Provider Identifier
1619188281
Registry record updated Feb 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
52685 Issued in MA
Legal business name
WEBSTER SQUARE MEDICAL CENTER, INC
Practice address
255 Park Ave
Suite 400
Worcester, MA 01609-1953
Phone
(508) 755-9776
Fax
(508) 793-0715
NPI assigned
May 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2012

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

Authorized official

Name
Dr. Walter Keaton Goljan, M.D.
Title
President
Phone
(508) 755-9776

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 52685 MA Primary

Addresses

Primary practice location

255 Park Ave
Suite 400
Worcester, MA 01609-1953

Mailing address

255 Park Ave
Suite 400
Worcester, MA 01609-1953
Phone (508) 755-9776

Other identifiers 2

IdentifierTypeStateIssuer
9768939MedicaidMA
Z096803MedicaidMA

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ABFBAA

NPI Registry JSON

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329782400000",
    "number": "1619188281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 PARK AVE",
            "address_2": "SUITE 400",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091953",
            "telephone_number": "508-755-9776",
            "fax_number": "508-793-0715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 PARK AVE",
            "address_2": "SUITE 400",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091953",
            "telephone_number": "508-755-9776",
            "fax_number": "508-793-0715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEBSTER SQUARE MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2012-02-21",
        "status": "A",
        "authorized_official_last_name": "GOLJAN",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "KEATON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "508-755-9776",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "52685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9768939",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z096803",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2012; 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.