NPIMap

Organization Active NPI

Fenway Community Health Center, Inc

  • Internal Medicine Physician
  • Cambridge, MA
National Provider Identifier
1689318503
Registry record updated Apr 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
FENWAY COMMUNITY HEALTH CENTER, INC
Practice address
359 Green St
Cambridge, MA 02139-3334
Phone
(617) 927-6050
NPI assigned
Apr 26, 2022
Organization subpart
Yes
Parent organization
FENWAY COMMUNITY HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 26, 2022

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

Authorized official

Name
Moire Daniel
Title
Director of Billing and Collections
Phone
(617) 927-6279

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

359 Green St
Cambridge, MA 02139-3334

Mailing address

PO Box 847492
Boston, MA 02284-7492
Phone (617) 927-6050

Other identifiers 1

IdentifierTypeStateIssuer
1303546MedicaidMA

Other names 1

  • Fenway Health Green Street Other name

National Provider Directory

National Provider Directory
Tax ID family
Fenway Comm Health Ctr6 organizations share this tax ID, including this one
Part of
Fenway Comm Health Ctr

Other organizations with this tax ID 5

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

Locations

359 Green St
Cambridge, MA 02139
Phone (617) 599-0245

Practitioners & affiliated clinicians

Practitioners 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1650931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650931200000",
    "number": "1689318503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 847492",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022847492",
            "telephone_number": "617-927-6050",
            "fax_number": "617-927-5410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "359 GREEN ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021393334",
            "telephone_number": "617-927-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FENWAY COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FENWAY COMMUNITY HEALTH CENTER, INC",
        "enumeration_date": "2022-04-26",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A",
        "authorized_official_last_name": "DANIEL",
        "authorized_official_first_name": "MOIRE",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING AND COLLECTIONS",
        "authorized_official_telephone_number": "617-927-6279"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1303546",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fenway Health Green Street",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cambridge, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2022; 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.