NPIMap

Organization Active NPI

Seacoast Affiliated Group Practice, Inc.

  • Clinic/Center
  • Newburyport, MA
National Provider Identifier
1801892344
Registry record updated Oct 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SEACOAST AFFILIATED GROUP PRACTICE, INC.
Practice address
25 Highland Ave
Newburyport, MA 01950-3867
Phone
(978) 463-1390
Fax
(978) 463-1190
NPI assigned
Jun 21, 2005
Last updated
Oct 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2015

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

Authorized official

Name
Mark Goldstein
Title
President/Ceo
Phone
(978) 463-1010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

25 Highland Ave
Newburyport, MA 01950-3867

Mailing address

25 Highland Ave
Newburyport, MA 01950-3867
Phone (978) 463-1390

Other identifiers 1

IdentifierTypeStateIssuer
9785906MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040628001193 MA Part B Supplier - Clinic/Group Practice 1658357843 Receives reassigned benefits from 91 practitioners
Practice locations: Newburyport, MA; Middleton, MA; Haverhill, MA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

600 Primrose St
Ste 202
Haverhill, MA 01830
Phone (978) 556-0100

1 Wallace Bashaw Way
Newburyport, MA 01950
Phone (888) 298-8127

1 Wallace Bashaw Way
Ste 2002
Newburyport, MA 01950
Phone (978) 463-8686

255 Low St
Ste 101
Newburyport, MA 01950
Phone (978) 255-4607

255 Low St
Ste 102
Newburyport, MA 01950
Phone (978) 463-1000

255 Low St
Ste 2
Newburyport, MA 01950
Phone (978) 465-4622

255 Low St
Ste 201
Newburyport, MA 01950
Phone (978) 465-4622

28 Green St
Newburyport, MA 01950
Phone (978) 465-1234

Practitioners & affiliated clinicians

Practitioners 143

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 143

NPI Registry JSON

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444348800000",
    "number": "1801892344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 HIGHLAND AVE",
            "city": "NEWBURYPORT",
            "state": "MA",
            "postal_code": "019503867",
            "telephone_number": "978-463-1390",
            "fax_number": "978-463-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 HIGHLAND AVE",
            "city": "NEWBURYPORT",
            "state": "MA",
            "postal_code": "019503867",
            "telephone_number": "978-463-1390",
            "fax_number": "978-463-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEACOAST AFFILIATED GROUP PRACTICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2015-10-09",
        "status": "A",
        "authorized_official_last_name": "GOLDSTEIN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "978-463-1010"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9785906",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newburyport, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.