NPIMap

Organization Active NPI

Square Medical Group LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Watertown, MA
National Provider Identifier
1760957609
Registry record updated Oct 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
SQUARE MEDICAL GROUP LLC
Practice address
124 Watertown St Ste 2D
Watertown, MA 02472-2599
Phone
(617) 916-5069
NPI assigned
Oct 8, 2018
Last updated
Oct 8, 2018By the provider in NPPES
Organization subpart
Yes

NPPES NPI Registry

Updated by the provider on Oct 8, 2018

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

Authorized official

Name
Jeff Gershman
Title
Ceo
Phone
(617) 916-5069

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

124 Watertown St Ste 2D
Watertown, MA 02472-2599

Mailing address

124 Watertown St Ste 2D
Watertown, MA 02472-2599
Phone (617) 916-5069

Other names 1

  • Square IOT Services Other name

National Provider Directory

National Provider Directory
Tax ID family
Square Medical Group LLC2 organizations share this tax ID, including this one
Part of
Square Medical Group LLC

Other organizations with this tax ID 1

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

Locations

124 Watertown St
Ste 2D
Watertown, MA 02472
Phone (617) 916-5096

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1538956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538956800000",
    "number": "1760957609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 WATERTOWN ST STE 2D",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024722599",
            "telephone_number": "617-916-5069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 WATERTOWN ST STE 2D",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024722599",
            "telephone_number": "617-916-5069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SQUARE MEDICAL GROUP LLC",
        "organizational_subpart": "YES",
        "enumeration_date": "2018-10-08",
        "last_updated": "2018-10-08",
        "status": "A",
        "authorized_official_last_name": "GERSHMAN",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "617-916-5069"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Square IOT Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Watertown, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2018; 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.