NPIMap

Organization Active NPI

Mass Bay Urologic Assoc

  • Urology Physician
  • Dorchester Center, MA
National Provider Identifier
1730189341
Registry record updated Sep 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
57617 Issued in MA
Legal business name
MASS BAY UROLOGIC ASSOC
Practice address
2100 Dorchester Ave
Suite 2206
Dorchester Center, MA 02124-5615
Phone
(617) 296-2222
Fax
(617) 296-3834
NPI assigned
Jul 26, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2010

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

Authorized official

Name
Clifford D Gluck, M.D.
Title
Owner
Phone
(617) 296-2222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X 57617 MA Primary

Addresses

Primary practice location

2100 Dorchester Ave
Suite 2206
Dorchester Center, MA 02124-5615

Mailing address

72 Sharp St
Hingham, MA 02043-4351
Phone (781) 337-0201

Other identifiers 2

IdentifierTypeStateIssuer
M16068OtherMABC/BS MA
9774106MedicaidMA

National Provider Directory

National Provider Directory

Locations

2100 Dorchester Ave
#S2206
Dorchestr Ctr, MA 02124
Phone (617) 296-2222

72 Sharp St
Hingham, MA 02043
Phone (617) 749-9071

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285286400000",
    "number": "1730189341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 SHARP ST",
            "city": "HINGHAM",
            "state": "MA",
            "postal_code": "020434351",
            "telephone_number": "781-337-0201",
            "fax_number": "781-335-3674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 DORCHESTER AVE",
            "address_2": "SUITE 2206",
            "city": "DORCHESTER CENTER",
            "state": "MA",
            "postal_code": "021245615",
            "telephone_number": "617-296-2222",
            "fax_number": "617-296-3834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASS BAY UROLOGIC ASSOC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-26",
        "last_updated": "2010-09-24",
        "status": "A",
        "authorized_official_last_name": "GLUCK",
        "authorized_official_first_name": "CLIFFORD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-296-2222",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "MA",
            "license": "57617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS MA",
            "identifier": "M16068",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9774106",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dorchester Center, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2010; 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.