NPIMap

Organization Active NPI

Charles River Community Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Waltham, MA
National Provider Identifier
1750486106
Registry record updated Apr 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
4157 Issued in MA
Legal business name
CHARLES RIVER COMMUNITY HEALTH, INC
Practice address
43 Foundry Ave Ste 110
Waltham, MA 02453-8313
Phone
(781) 693-3800
Fax
(781) 693-3817
NPI assigned
Sep 13, 2006
Last updated
Apr 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2026

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

Authorized official

Name
Matthew Lockwood Mullaney
Title
Ceo
Phone
(617) 783-0500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 4157 MA Primary

Addresses

Primary practice location

43 Foundry Ave Ste 110
Waltham, MA 02453-8313

Mailing address

495 Western Ave
Brighton, MA 02135-1007
Phone (781) 693-3800

Other identifiers 8

IdentifierTypeStateIssuer
2227002110OtherMABCBS
1320882MedicaidMA
W20419OtherMABCBS - OPTOMETRY
903699OtherMATUFTS HEALTH PLAN - MH
M12043OtherMABCBS MEDICAL/PODIATRY
686893OtherMATUFTS HEALTH PLAN
110024306TMedicaidMA
682536OtherMATUFTS HEALTH PLAN - MED

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040820000310 MA Part B Supplier - Clinic/Group Practice 5294709812 Receives reassigned benefits from 43 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brighton, MA; Waltham, MA
O20041207000910 MA Part A Provider - Federally Qualified Health Center (FQHC) 5294709812 Practice locations: Waltham, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750486106. Details of each certification follow.

Federally qualified health center certification: CCN 221861

Legal name
CHARLES RIVER COMMUNITY HEALTH, INC
Doing business as
BRIGHTON-ALLSTON COMMUNITY HEALTH CORPORATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 13, 2005
Last certification
Jan 13, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 10, 1970 in MA
Enrollment address
43 Foundry Ave
Ste 110
Waltham, MA 24538313
Related CCNs
221800

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
JM Smith Community Heal7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

495 Western Ave
Brighton, MA 02135

43 Foundry Ave
Waltham, MA 02453
Phone (781) 693-3800

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Keplin Allwaters Individual Corporate OfficerBoard Member Jan 1, 2025
Steven Kent Individual Corporate Officer Jan 1, 2017
Modupe Mohammed Individual Corporate OfficerClerk Mar 2, 2021
Molly Colwell Individual Corporate OfficerBoard Member Jan 1, 2025
Jacqueline Herrera Individual Corporate OfficerBoard Member Jan 1, 2025
Margaret Kelly Individual Corporate OfficerBoard Member Jan 1, 2025
Robert Woodworth Individual Corporate OfficerTreasurer Jan 1, 2017
Evelyn Evet Cepero Torres Individual W-2 Managing EmployeeAd; May 24, 1999
Anne Levine Individual Corporate OfficerBoard Member Jan 1, 2025
Amie Pollack Individual Corporate Officer Jan 1, 2025
Gabriela Canepa Individual Corporate Director Jan 1, 2010
Matthew L Lockwood Mullaney Individual Corporate DirectorCeo Dec 16, 2024 100%
W-2 Managing EmployeeCeo Dec 16, 2024 100%

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776124800000",
    "number": "1750486106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 WESTERN AVE",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021351007",
            "telephone_number": "781-693-3800",
            "fax_number": "781-693-3817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 FOUNDRY AVE STE 110",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024538313",
            "telephone_number": "781-693-3800",
            "fax_number": "781-693-3817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES RIVER COMMUNITY HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2026-04-14",
        "certification_date": "2026-04-14",
        "status": "A",
        "authorized_official_last_name": "LOCKWOOD MULLANEY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "617-783-0500"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MA",
            "license": "4157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2227002110",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1320882",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - OPTOMETRY",
            "identifier": "W20419",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN - MH",
            "identifier": "903699",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MEDICAL/PODIATRY",
            "identifier": "M12043",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "686893",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110024306T",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN - MED",
            "identifier": "682536",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

Verify at the official NPI Registry.