NPIMap

Organization Active NPI

North Shore Community Health, Inc

Doing business as Gloucester Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Gloucester, MA
National Provider Identifier
1710233572
Registry record updated Sep 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
4M9K Issued in MA
Legal business name
NORTH SHORE COMMUNITY HEALTH, INC
Doing business as
Gloucester Family Health Center
Practice address
302 Washington St
Gloucester, MA 01930-4836
Phone
(978) 282-8899
Fax
(978) 236-0290
NPI assigned
Jul 31, 2012
Last updated
Sep 27, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTH SHORE COMMUNITY HEALTH, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 27, 2012

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

Authorized official

Name
Margaret Brennan, MPH
Title
Ceo
Phone
(978) 825-1109

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 4M9K MA Primary

Addresses

Primary practice location

302 Washington St
Gloucester, MA 01930-4836

Mailing address

27 Congress St
Suite 103
Salem, MA 01970-7309
Phone (978) 744-8388

Other names 1

  • Gloucester Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040812001007 MA Part B Supplier - Clinic/Group Practice 4880666452 Receives reassigned benefits from 45 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salem, MA
O20130501000628 MA Part A Provider - Federally Qualified Health Center (FQHC) 4880666452 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salem, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710233572. Details of each certification follow.

Federally qualified health center certification: CCN 221917

Legal name
NORTH SHORE COMMUNITY HEALTH INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 22, 2013
Last certification
Apr 22, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1977 in MA
Enrollment address
47 Congress St
Salem, MA 19707308

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
North Shore Cummunity H

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tammy Lamonde Individual Corporate DirectorBoard Member Apr 25, 2019
Matthew a. Veno Individual Corporate DirectorBoard Member - Executive Comm Jul 28, 2022
Lucy Corchado Individual Corporate DirectorBoard Member - Executive Comm Jun 30, 2015
Aisha Strauss Individual Corporate DirectorBoard Member Sep 28, 2023
Jennifer Femino Individual Corporate DirectorBoard Member Jul 28, 2022
Jarissie Echavarria Individual Corporate DirectorBoard Member Sep 24, 2024
North Shore Community Health Inc Organization, Gloucester, MA Non-profit Operational/Managerial Control Sep 12, 2011
Margaret Brennan Individual Corporate OfficerPresident and Ceo Sep 12, 2011
W-2 Managing EmployeePresident and Ceo Sep 12, 2011
Operational/Managerial ControlPresident and Ceo Sep 12, 2011
Amy Leach Individual Corporate DirectorBoard Member - Executive Comm Jul 18, 2018
William Sullivan Individual Corporate DirectorBoard Member - Treasuer-Executive Jul 18, 2018
Marion E. Winfrey Individual Corporate DirectorBoard Member - Clerk Jun 1, 2018

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1343692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348704000000",
    "number": "1710233572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 CONGRESS ST",
            "address_2": "SUITE 103",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019707309",
            "telephone_number": "978-744-8388",
            "fax_number": "978-744-0079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 WASHINGTON ST",
            "city": "GLOUCESTER",
            "state": "MA",
            "postal_code": "019304836",
            "telephone_number": "978-282-8899",
            "fax_number": "978-236-0290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE COMMUNITY HEALTH, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH SHORE COMMUNITY HEALTH, INC",
        "enumeration_date": "2012-07-31",
        "last_updated": "2012-09-27",
        "status": "A",
        "authorized_official_last_name": "BRENNAN",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "978-825-1109",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MA",
            "license": "4M9K",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gloucester Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gloucester, MA

Sources for this page

Verify at the official NPI Registry.