NPIMap

Organization Active NPI

Pioneer Valley Urology, PC

  • Urology Physician
  • Springfield, MA
National Provider Identifier
1750315982
Registry record updated Jul 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
PIONEER VALLEY UROLOGY, PC
Practice address
100 Wason Avenue
Suite 120
Springfield, MA 01107-0119
Phone
(413) 241-2100
Fax
(413) 735-2012
NPI assigned
Jul 11, 2006
Last updated
Jul 12, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2010

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

Authorized official

Name
Sally Gellock
Title
Credentialing
Phone
(413) 241-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X Primary

Addresses

Primary practice location

100 Wason Avenue
Suite 120
Springfield, MA 01107-0119

Mailing address

100 Wason Avenue
Suite 120
Springfield, MA 01107-0119
Phone (413) 241-2100

Other identifiers 2

IdentifierTypeStateIssuer
9774424MedicaidMA
M16033OtherMABLUE CROSS OF MA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, CT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050621000419 MA Part B Supplier - Clinic/Group Practice 7214972207 Receives reassigned benefits from 32 practitioners
Practice locations: Springfield, MA; Palmer, MA
O20160923001041 CT Part B Supplier - Clinic/Group Practice 7214972207 Receives reassigned benefits from 6 practitioners
Practice locations: Enfield, CT

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
22D0067746Pioneer Valley Urology, PC100 Wason Ave, Suite 120, Springfield, MA 01107ComplianceApr 26, 2028

National Provider Directory

National Provider Directory

Locations

113 Elm St
Ste 206
Enfield, CT 06082
Phone (860) 741-2177

15 Palomba Dr
Ste 7
Enfield, CT 06082

1294 Ware St
Palmer, MA 01069
Phone (413) 241-2100

100 Wason Ave
Ste 120
Springfield, MA 01107
Phone (413) 241-2100

2 Medical Center Dr
Ste 308
Springfield, MA 01107
Phone (413) 794-7020

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.60885

Practitioners & affiliated clinicians

Practitioners 36

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.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278892800000",
    "number": "1750315982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WASON AVENUE",
            "address_2": "SUITE 120",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011070119",
            "telephone_number": "413-241-2100",
            "fax_number": "413-241-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WASON AVENUE",
            "address_2": "SUITE 120",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011070119",
            "telephone_number": "413-241-2100",
            "fax_number": "413-735-2012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIONEER VALLEY UROLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2010-07-12",
        "status": "A",
        "authorized_official_last_name": "GELLOCK",
        "authorized_official_first_name": "SALLY",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "413-241-2100"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9774424",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MA",
            "identifier": "M16033",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.