Active NPI
Michelle A Jack, RN
- Registered Nurse
- Mattapan, MA
National Provider Identifier
1720165715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 252437
- Practice address
- 1425 Blue Hill Avenue
Mattapan Community Health Center
Mattapan, MA 02126 - Phone
- (617) 898-9013
- Fax
- (617) 296-1421
- NPI assigned
- Nov 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 252437 | MA | Primary |
Addresses
Primary practice location
1425 Blue Hill Avenue
Mattapan Community Health Center
Mattapan, MA 02126
Mailing address
5 Seiden St
Dorchester, MA 02124
Phone (617) 822-7523
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 252437 | MA | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mattapan Community Health Center Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Mattapan, MA
- NPI 1639240393
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720165715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 SEIDEN ST",
"city": "DORCHESTER",
"state": "MA",
"postal_code": "02124",
"telephone_number": "617-822-7523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1425 BLUE HILL AVENUE",
"address_2": "MATTAPAN COMMUNITY HEALTH CENTER",
"city": "MATTAPAN",
"state": "MA",
"postal_code": "02126",
"telephone_number": "617-898-9013",
"fax_number": "617-296-1421"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACK",
"first_name": "MICHELLE",
"middle_name": "A",
"name_prefix": "Ms.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MA",
"license": "252437",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mattapan, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.