NPIMap

Organization Active NPI

Northern Berkshire Sports Medicine Inc

  • Specialist
  • North Adams, MA
National Provider Identifier
1750440277
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
053990 Issued in MA
Legal business name
NORTHERN BERKSHIRE SPORTS MEDICINE INC
Practice address
40 Main Street
Suite 103
North Adams, MA 01247-3416
Phone
(413) 663-5450
Fax
(413) 664-8737
NPI assigned
Dec 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Paul J Donovan, DONPI 1952351744
Title
Medical Director
Phone
(413) 663-5450

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 053990 MA Primary

Addresses

Primary practice location

40 Main Street
Suite 103
North Adams, MA 01247-3416

Mailing address

40 Main Street
Suite 103
North Adams, MA 01247-3416
Phone (413) 663-5450

Other identifiers 2

IdentifierTypeStateIssuer
9773398MedicaidMA
M15970OtherMABLUE SHIELD GROUP NUMBER

National Provider Directory

National Provider Directory

Locations

40 Main St
Ste 103
North Adams, MA 01247
Phone (413) 663-5450

Practitioners & affiliated clinicians

Practitioners 1

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": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750440277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 MAIN STREET",
            "address_2": "SUITE 103",
            "city": "NORTH ADAMS",
            "state": "MA",
            "postal_code": "012473416",
            "telephone_number": "413-663-5450",
            "fax_number": "413-664-8737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 MAIN STREET",
            "address_2": "SUITE 103",
            "city": "NORTH ADAMS",
            "state": "MA",
            "postal_code": "012473416",
            "telephone_number": "413-663-5450",
            "fax_number": "413-664-8737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN BERKSHIRE SPORTS MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DONOVAN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "413-663-5450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MA",
            "license": "053990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9773398",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP NUMBER",
            "identifier": "M15970",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Adams, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.