NPIMap

Organization Active NPI

Renaissance Primary Care, LLC

  • Internal Medicine Physician
  • Southbridge, MA
National Provider Identifier
1649729021
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
RENAISSANCE PRIMARY CARE, LLC
Practice address
11-15 Sandersdale Road
Southbridge, MA 01550
Phone
(774) 420-2311
Fax
(508) 519-0763
NPI assigned
Sep 27, 2016
Last updated
Jul 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2025

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

Authorized official

Name
Dr. James Manuel, PSYCHOLOGISTNPI 1982849352
Title
Psychologist
Phone
(774) 420-2311

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU
Mental Health Counselor 101YM0800X NU
Psychologist 103T00000X NU
Internal Medicine Physician 207R00000X NU Primary
Psychiatry Physician 2084P0800X NU

Addresses

Primary practice location

11-15 Sandersdale Road
Southbridge, MA 01550

Mailing address

11-15 Sandersdale Road
Southbridge, MA 01550
Phone (774) 420-2311

Other practice location 1

112 Westfield St
West Springfield, MA 01089-2577
Phone (774) 340-8791

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161117000334 MA Part B Supplier - Clinic/Group Practice 3476832379 Receives reassigned benefits from 9 practitioners
Practice locations: Southbridge, MA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D2121440Renaissance Primary Care, LLC11-15 Sandersdale Rd, Southbridge, MA 01550Certificate of waiverNov 3, 2026

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24582/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1474934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752537600000",
    "number": "1649729021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11-15 SANDERSDALE ROAD",
            "city": "SOUTHBRIDGE",
            "state": "MA",
            "postal_code": "01550",
            "telephone_number": "774-420-2311",
            "fax_number": "508-519-0763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11-15 SANDERSDALE ROAD",
            "city": "SOUTHBRIDGE",
            "state": "MA",
            "postal_code": "01550",
            "telephone_number": "774-420-2311",
            "fax_number": "508-519-0763"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112 Westfield St",
            "address_purpose": "LOCATION",
            "city": "West Springfield",
            "state": "MA",
            "postal_code": "010892577",
            "country_code": "US",
            "telephone_number": "774-340-8791",
            "fax_number": "508-519-0763",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RENAISSANCE PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-27",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A",
        "authorized_official_last_name": "MANUEL",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "774-420-2311",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYCHOLOGIST"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southbridge, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.