Active NPI
Brockton Hospital, Inc.
- Psychiatric Hospital Unit
- Brockton, MA
National Provider Identifier
1689695405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric Hospital Unit
- License
- 2118
- Legal business name
- BROCKTON HOSPITAL, INC.
- Practice address
- 680 Centre St
Brockton, MA 02302-3308 - Phone
- (508) 941-7000
- NPI assigned
- Jul 21, 2006
- Organization subpart
- Yes
- Parent organization
- BROCKTON HOSPITAL, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert Joseph Haffey
- Title
- Ceo
- Phone
- (508) 941-7000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Hospital Unit | 273R00000X | 2118 | MA | Primary |
Addresses
Primary practice location
680 Centre St
Brockton, MA 02302-3308
Mailing address
680 Centre St
Brockton, MA 02302-3395
Phone (508) 941-7555
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110026502B | Medicaid | MA | |
| 110026502C | Medicaid | MA |
Other names 1
- Signature Healthcare Brockton Hospital
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200228000498 | MA | Part A Provider - Hospital | 4082504733 | Practice locations: Brockton, MA |
Hospital certification: CCN 22S052
- Legal name
- BROCKTON HOSPITAL, INC.
- Doing business as
- SIGNATURE HEALTHCARE BROCKTON HOSPITAL
- Organization structure
- Corporation
- Incorporated
- Apr 21, 1983 in MA
- Enrollment address
- 680 Centre St
Brockton, MA 23023308 - Hospital subgroups
- Psychiatric unit
Related certifications (CCN) 1
Facilities connected through Provider of Services related, parent or unit certification numbers.
Other NPIs with the same Medicare PAC ID 3
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Part of
- Brockton Hospital
Ownership & related parties
All disclosed owners & managing parties 20
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Joseph P Drier | Corporate Director | Jan 1, 2021 | |
| Cynthia M Colby | W-2 Managing Employee | Aug 1, 2018 | |
| Patti Roland | Corporate Director | Jan 1, 2021 | |
| Michael L Dern | Corporate Director | Jan 1, 2021 | |
| Cheryl McCallion | Corporate Director | Jan 1, 2023 | |
| Dale J Ellenberg | Corporate Director | Jan 1, 2023 | |
| Michael J Sullivan | Corporate Director | Jan 1, 2021 | |
| Luke McCabe | Corporate Director | Jan 1, 2021 | |
| David F Engelkemeyer | Corporate Director | Jan 1, 2021 | |
| Deepti Seshadri | Corporate Director | Jan 1, 2023 | |
| Alfred Niccoli | Corporate Director | Jan 1, 2021 | |
| David a Drinkwater | Corporate Director | Jan 1, 2021 | |
| Edward Smith | Corporate Director | Jan 1, 2023 | |
| David M Offutt | Corporate Director | Jan 1, 2021 | |
| Vincent Marturano | Corporate Director | Jan 1, 2023 | |
| James E Leary | Corporate Director | Jan 1, 2021 | |
| Clara F Miranda | Corporate Director | Jan 1, 2023 | |
| Joseph L Tansey | Corporate Director | Jan 1, 2021 | |
| Maria Harris | Corporate Director | Jan 1, 2021 | |
| Robert Haffey | Corporate Officer | Nov 29, 2021 | |
| Corporate Director | Nov 29, 2021 | ||
| W-2 Managing Employee | Nov 29, 2021 |
Owners & managing parties with NPI records 2
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
Practitioners & affiliated clinicians
Practitioners 41
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1712188800000",
"number": "1689695405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "680 CENTRE ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023023395",
"telephone_number": "508-941-7555",
"fax_number": "508-941-6303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "680 CENTRE ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023023308",
"telephone_number": "508-941-7000"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BROCKTON HOSPITAL, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BROCKTON HOSPITAL, INC.",
"enumeration_date": "2006-07-21",
"last_updated": "2024-04-04",
"certification_date": "2023-10-03",
"status": "A",
"authorized_official_last_name": "HAFFEY",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "JOSEPH",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "508-941-7000"
},
"taxonomies": [
{
"code": "273R00000X",
"taxonomy_group": "",
"desc": "Psychiatric Unit",
"state": "MA",
"license": "2118",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110026502B",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110026502C",
"state": "MA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Signature Healthcare Brockton Hospital",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Signature Healthcare Brockton Hospital",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.