NPIMap

Organization Active NPI

Preventive Medicine Associates

  • Addiction Medicine (Family Medicine) Physician
  • Roxbury, MA
National Provider Identifier
1659679793
Registry record updated Mar 13, 2011
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
Roxbury Wellness Center
Practice address
2201 Washington St
Suite 302
Roxbury, MA 02119-3212
Phone
(617) 541-8090
Fax
(617) 541-8094
NPI assigned
Mar 13, 2011
Organization subpart
Yes
Parent organization
PREVENTIVE MEDICINE ASSOCIATESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 13, 2011

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) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X Primary

Addresses

Primary practice location

2201 Washington St
Suite 302
Roxbury, MA 02119-3212

Mailing address

2201 Washington St
Suite 302
Roxbury, MA 02119-3212
Phone (617) 541-8090

Other names 1

  • Roxbury Wellness Center 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

Locations

2201 Washington St
Ste 302
Roxbury, MA 02119
Phone (617) 541-8090

NPI Registry JSON

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

{
    "created_epoch": "1299974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299974400000",
    "number": "1659679793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 WASHINGTON ST",
            "address_2": "SUITE 302",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021193212",
            "telephone_number": "617-541-8090",
            "fax_number": "617-541-8094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 WASHINGTON ST",
            "address_2": "SUITE 302",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021193212",
            "telephone_number": "617-541-8090",
            "fax_number": "617-541-8094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVENTIVE MEDICINE ASSOCIATES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREVENTIVE MEDICINE ASSOCIATES",
        "enumeration_date": "2011-03-13",
        "last_updated": "2011-03-13",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roxbury Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roxbury, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2011; 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.