NPIMap

Organization Active NPI

Preventive Medicine Associates

Doing business as West Roxbury Wellness Pavillion

  • Addiction Medicine (Family Medicine) Physician
  • West Roxbury, MA
National Provider Identifier
1629302112
Registry record updated Sep 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
Legal business name
PREVENTIVE MEDICINE ASSOCIATES
Doing business as
West Roxbury Wellness Pavillion
Practice address
1208B VFW Pkwy
Suite 305
West Roxbury, MA 02132-4349
Phone
(617) 477-8294
Fax
(617) 477-8294
NPI assigned
Sep 30, 2009
Last updated
Sep 30, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
PREVENTIVE MEDICINE ASSOCIATESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 30, 2009

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

Authorized official

Name
Ms. Mary J Delong, MM,RHIA
Title
Credentialing Manager
Phone
(413) 222-7711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) Physician 207QA0401X Primary

Addresses

Primary practice location

1208B VFW Pkwy
Suite 305
West Roxbury, MA 02132-4349

Mailing address

1208B VFW Pkwy
Suite 305
West Roxbury, MA 02132-4349
Phone (617) 477-8294

Other names 1

  • West Roxbury Wellness Pavillion Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Springfield International Health Center29 organizations share this tax ID, including this one
Part of
Springfield International Health Center

Other organizations with this tax ID 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1254268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254268800000",
    "number": "1629302112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208B VFW PKWY",
            "address_2": "SUITE 305",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021324349",
            "telephone_number": "617-477-8294",
            "fax_number": "617-477-8294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208B VFW PKWY",
            "address_2": "SUITE 305",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021324349",
            "telephone_number": "617-477-8294",
            "fax_number": "617-477-8294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVENTIVE MEDICINE ASSOCIATES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREVENTIVE MEDICINE ASSOCIATES",
        "enumeration_date": "2009-09-30",
        "last_updated": "2009-09-30",
        "status": "A",
        "authorized_official_last_name": "DELONG",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "413-222-7711",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MM,RHIA"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Roxbury Wellness Pavillion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Roxbury, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2009; 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.