NPIMap

Organization Active NPI

Northern Berkshire Pediatrics, LLP

  • Pediatrics Physician
  • North Adams, MA
National Provider Identifier
1750596201
Registry record updated Mar 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
NORTHERN BERKSHIRE PEDIATRICS, LLP
Practice address
77 Hospital Ave.
Suite 302
North Adams, MA 01247-2538
Phone
(413) 663-8365
Fax
(413) 662-2363
NPI assigned
May 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2012

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

Authorized official

Name
Susan King
Title
Practice Manager
Phone
(413) 663-8365

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X MA Primary

Addresses

Primary practice location

77 Hospital Ave.
Suite 302
North Adams, MA 01247-2538

Mailing address

77 Hospital Ave., Suite 302
Ambulatory Care Center
North Adams, MA 01247-2538
Phone (413) 663-8365

Other identifiers 1

IdentifierTypeStateIssuer
0134791MedicaidMA

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
22D0068241Northern Berkshire Pediatrics LLP77 Hospital Avenue Suite 302, North Adams, MA 01247Certificate of waiverNov 30, 2027

National Provider Directory

National Provider Directory

Locations

19 Depot St
Ste 1
Adams, MA 01220
Phone (413) 743-1080

77 Hospital Ave
Ste 302
North Adams, MA 01247
Phone (413) 663-8365

77 Hospital Ave
Ste 104
North Adams, MA 01247
Phone (413) 398-5180

181 Main St
Williamstown, MA 01267

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330905600000",
    "number": "1750596201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 HOSPITAL AVE., SUITE 302",
            "address_2": "AMBULATORY CARE CENTER",
            "city": "NORTH ADAMS",
            "state": "MA",
            "postal_code": "012472538",
            "telephone_number": "413-663-8365",
            "fax_number": "413-662-2363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 HOSPITAL AVE.",
            "address_2": "SUITE 302",
            "city": "NORTH ADAMS",
            "state": "MA",
            "postal_code": "012472538",
            "telephone_number": "413-663-8365",
            "fax_number": "413-662-2363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN BERKSHIRE PEDIATRICS, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2012-03-05",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "413-663-8365"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0134791",
            "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 Mar 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.