NPIMap

Organization Active NPI

Bridgecare Provider Group Ma, PLLC

  • Nurse Practitioner
  • Concord, MA
National Provider Identifier
1679366298
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
BRIDGECARE PROVIDER GROUP MA, PLLC
Practice address
57 Old Road to 9 Acre Cor
Concord, MA 01742-3317
Phone
(551) 337-3278
NPI assigned
May 27, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2025

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

Authorized official

Name
Marivic Vanover (Jed) Vanover, NURSE PRACTITIONERNPI 1710450713
Title
Vice President of Operation
Phone
(856) 448-3533

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

57 Old Road to 9 Acre Cor
Concord, MA 01742-3317

Mailing address

57 Old Road to 9 Acre Cor
Concord, MA 01742-3317
Phone (551) 337-3278

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250929002384 MA Part B Supplier - Clinic/Group Practice 9638675762 Receives reassigned benefits from 5 practitioners
Practice locations: Concord, MA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1748304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748304000000",
    "number": "1679366298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 OLD ROAD TO 9 ACRE COR",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017423317",
            "telephone_number": "551-337-3278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 OLD ROAD TO 9 ACRE COR",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017423317",
            "telephone_number": "551-337-3278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGECARE PROVIDER GROUP MA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-27",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A",
        "authorized_official_last_name": "VANOVER",
        "authorized_official_first_name": "MARIVIC",
        "authorized_official_middle_name": "VANOVER (JED)",
        "authorized_official_title_or_position": "VICE PRESIDENT OF OPERATION",
        "authorized_official_telephone_number": "856-448-3533",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2025; 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.