NPIMap

Organization Active NPI

Upham'S Corner Health Committee, Inc.

  • Community Health Clinic/Center
  • Dorchester, MA
National Provider Identifier
1780780486
Registry record updated Jul 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
UPHAM'S CORNER HEALTH COMMITTEE, INC.
Practice address
500 Columbia Rd
Dorchester, MA 02125-2322
Phone
(617) 287-8000
Fax
(617) 282-8625
NPI assigned
Sep 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2017

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

Authorized official

Name
Mr. Jagdeep Trivedi
Title
Ceo
Phone
(617) 740-8131

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary
Dental Clinic/Center 261QD0000X
Non-Surgical Family Planning Clinic/Center 261QF0050X
Federally Qualified Health Center (FQHC) 261QF0400X 490 MA
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Medical Specialty Clinic/Center 261QM2500X
Podiatric Clinic/Center 261QP1100X
Primary Care Clinic/Center 261QP2300X
Urgent Care Clinic/Center 261QU0200X
Clinical Medical Laboratory 291U00000X
Dental Laboratory 292200000X

Addresses

Primary practice location

500 Columbia Rd
Dorchester, MA 02125-2322

Mailing address

500 Columbia Rd
Dorchester, MA 02125-2322
Phone (617) 287-8000

Other identifiers 1

IdentifierTypeStateIssuer
1301977MedicaidMA

Other names 1

  • Upham's Corner Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20060508000841 MA Part B Supplier - Clinic/Group Practice 4284645086 Receives reassigned benefits from 55 practitioners
Practice locations: Dorchester, MA
O20100426000035 MA Part A Provider - Federally Qualified Health Center (FQHC) 4284645086 Practice locations: Dorchester, MA
O20151118001892 MA Part A Provider - Federally Qualified Health Center (FQHC) 4284645086 Practice locations: Dorchester, MA
O20151118002748 MA Part A Provider - Federally Qualified Health Center (FQHC) 4284645086 Practice locations: Dorchester, MA

Federally qualified health center certification: CCN 221828

Legal name
UPHAMS CORNER HEALTH COMMITTEE INC
Doing business as
UPHAMS CORNER HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 24, 1994
Last certification
Aug 24, 1994
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Dec 29, 1971 in MA
Enrollment address
500 Columbia Rd
Dorchester, MA 21252322
Related CCNs
227198

Federally qualified health center certification: CCN 221936

Legal name
UPHAMS CORNER HEALTH COMMITTEE INC
Doing business as
UPHAM'S CORNER HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 17, 2015
Last certification
Dec 17, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 29, 1971 in MA
Enrollment address
415 Columbia Road
Mail Stop 415-01
Dorchester, MA 21252424

Federally qualified health center certification: CCN 221935

Legal name
UPHAMS CORNER HEALTH COMMITTEE INC
Doing business as
UPHAM'S CORNER HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 11, 2015
Last certification
Dec 11, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 29, 1971 in MA
Enrollment address
636 Columbia Road
Mail Stop 415-01
Dorchester, MA 21253416

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

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Locations

500 Columbia Rd
Stop 4151
Dorchester, MA 02125

500 Columbia Rd
Stop 415
Dorchester, MA 02125
Phone (617) 287-8000

636 Columbia Rd
Stop 41501
Dorchester, MA 02125
Phone (617) 287-8000

415 Columbia Rd
Stop 41501
Dorchester, MA 02125
Phone (617) 287-8000

636 Columbia Rd
Dorchester, MA 02125
Phone (617) 825-9839

415 Columbia Rd
Uphams Corner, MA 02125
Phone (617) 287-8000

415 Columbia Rd
Stop 415
Uphams Corner, MA 02125
Phone (617) 287-8000

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Dai Morehouse Individual Corporate Director Mar 4, 2010
Corporate OfficerBoard Member Jun 19, 2008
Uphams Corner Health Committee Inc Organization, Dorchester, MA Corporation Operational/Managerial Control Aug 24, 1994
Margaret Wirth Individual Corporate Director Mar 4, 2010
Corporate OfficerPresident of the Board of Direct Jun 1, 1978
Jagdeep Trivedi Individual Corporate OfficerCeo Jan 1, 2016 100%
W-2 Managing EmployeeCeo Jan 1, 2016 100%
Operational/Managerial ControlExecutive Director Aug 3, 2015 100%
Corporate Director Aug 3, 2015
Althea Garrison Individual Corporate Director Mar 4, 2010
Corporate OfficerBoard Member Jun 1, 1982
Edward F Grimes Individual Corporate DirectorCeo Jun 18, 1973 100%
W-2 Managing EmployeeCeo Jun 18, 1973 100%
Kevin Cherry Individual Corporate DirectorChief Financial Officer Dec 5, 2021
Operational/Managerial Control Feb 2, 2020
Maria a Cabral Individual Corporate OfficerBoard Member Jun 19, 2008

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Uphams Home Health CareDorchester, MA, CCN 227198 Home health agency Operational/Managerial Control (100%) Jan 1, 1987

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 67

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

View all 67

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499817600000",
    "number": "1780780486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 COLUMBIA RD",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021252322",
            "telephone_number": "617-287-8000",
            "fax_number": "617-282-8625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 COLUMBIA RD",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021252322",
            "telephone_number": "617-287-8000",
            "fax_number": "617-282-8625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPHAM'S CORNER HEALTH COMMITTEE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2017-07-12",
        "status": "A",
        "authorized_official_last_name": "TRIVEDI",
        "authorized_official_first_name": "JAGDEEP",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "617-740-8131",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MA",
            "license": "490",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "292200000X",
            "taxonomy_group": "",
            "desc": "Dental Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1301977",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Upham's Corner Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dorchester, MA

Sources for this page

Verify at the official NPI Registry.