NPIMap

Organization Active NPI

South Shore Medical Center, Inc.

  • Internal Medicine Physician
  • Norwell, MA
National Provider Identifier
1669411856
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SOUTH SHORE MEDICAL CENTER, INC.
Practice address
143 Longwater Drive
Norwell, MA 02061-1795
Phone
(781) 792-4191
Fax
(781) 878-6750
NPI assigned
Jun 5, 2006
Last updated
Jan 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Authorized official

Name
Ms. Jaclyn Valanzola
Title
Supervisor
Phone
(781) 681-0384

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207K00000X
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X
Rheumatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RR0500X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X

Addresses

Primary practice location

143 Longwater Drive
Norwell, MA 02061-1795

Mailing address

143 Longwater Dr
Norwell, MA 02061-1683
Phone (781) 792-4191

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040413000332 MA Part B Supplier - Clinic/Group Practice 3678487444 Receives reassigned benefits from 427 practitioners
Practice locations: Weymouth, MA; Whitman, MA; Hingham, MA; Kingston, MA; Norwell, MA; Quincy, MA; Plymouth, MA

National Provider Directory

National Provider Directory

Locations

5 Tarkiln Rd
Kingston, MA 02364
Phone (781) 585-2200

10 Granite St
Quincy, MA 02169
Phone (617) 328-3556

Practitioners & affiliated clinicians

Practitioners 429

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.

View all 429

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1669411856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 LONGWATER DR",
            "city": "NORWELL",
            "state": "MA",
            "postal_code": "020611683",
            "telephone_number": "781-792-4191",
            "fax_number": "781-878-6750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 LONGWATER DRIVE",
            "city": "NORWELL",
            "state": "MA",
            "postal_code": "020611795",
            "telephone_number": "781-792-4191",
            "fax_number": "781-878-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-05",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "VALANZOLA",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "781-681-0384",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwell, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.