NPIMap

Organization Active NPI

Mass General Waltham

  • Health Service Clinic/Center
  • Waltham, MA
National Provider Identifier
1710070313
Registry record updated Aug 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
MA0049076 Issued in MA
Legal business name
MASS GENERAL WALTHAM
Practice address
52 Second Ave FL 4
Waltham, MA 02451-1127
Phone
(781) 487-4390
Fax
(781) 487-4391
NPI assigned
Oct 2, 2006
Organization subpart
Yes
Parent organization
THE GENERAL HOSPITAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 31, 2022

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

Authorized official

Name
Sally Mason Boemer
Title
Evp of Administration & Finance
Phone
(617) 724-4537

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X MA0049076 MA Primary

Addresses

Primary practice location

52 Second Ave FL 4
Waltham, MA 02451-1127

Mailing address

55 Fruit St
Grb05-Attention Karen Ryle
Boston, MA 02114-2621
Phone (781) 487-4390

Other identifiers 1

IdentifierTypeStateIssuer
0447641MedicaidMA

Other names 1

  • General Hospital Corp Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Harvard Partners Center for Genetics and Genomics13 organizations share this tax ID, including this one
Part of
Harvard Partners Center for Genetics and Genomics

Other organizations with this tax ID 12

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

Locations

52 Second Ave
Fl 4
Waltham, MA 02451
Phone (781) 487-4390

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D0910050Mass General Waltham Internal Medicine52 Second Ave, Suite 400, Waltham, MA 02451Certificate of waiverAug 5, 2027
22D2002363Mass General Waltham Imaging52 Second Avenue Suite 140, Waltham, MA 02451Certificate of waiverJan 13, 2028
22D2045051Mass General Waltham Primary Care Associates52 Second Avenue, Waltham, MA 02451Provider-performed microscopyAug 5, 2026
22D2096202Mass General Waltham Laboratory52 Second Avenue Ste 1110, Waltham, MA 02451AccreditationFeb 15, 2028
22D2287917Mass General Urology - Waltham52 2ND Avenue, 3Rd Floor - Blue Building, Waltham, MA 02451Certificate of waiverAug 17, 2027
22D2315459Mass General Waltham PFT Lab52 Second Ave., Blue BLDG, 3Rd FL, Suite 3100, Waltham, MA 02451Certificate of waiverDec 11, 2026

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661904000000",
    "number": "1710070313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "address_2": "GRB05-ATTENTION KAREN RYLE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "781-487-4390",
            "fax_number": "781-487-4391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 SECOND AVE FL 4",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511127",
            "telephone_number": "781-487-4390",
            "fax_number": "781-487-4391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASS GENERAL WALTHAM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE GENERAL HOSPITAL CORPORATION",
        "enumeration_date": "2006-10-02",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A",
        "authorized_official_last_name": "BOEMER",
        "authorized_official_first_name": "SALLY",
        "authorized_official_middle_name": "MASON",
        "authorized_official_title_or_position": "EVP OF ADMINISTRATION & FINANCE",
        "authorized_official_telephone_number": "617-724-4537"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "MA",
            "license": "MA0049076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0447641",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "General Hospital Corp",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "General Hospital Corp",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waltham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.