Organization Active NPI

Family Practice Group PC

  • Family Medicine Physician
  • Arlington, MA
National Provider Identifier
1801953849
Registry record updated Jul 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAMILY PRACTICE GROUP PC
Practice address
11 Water St
Suite 1a
Arlington, MA 02476-4812
Phone
(781) 648-9700
Fax
(781) 648-0234
NPI assigned
Jan 2, 2007
Last updated
Jul 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2010

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

Authorized official

Name
Jennifer Hillery
Title
Administrator
Phone
(781) 648-9700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

11 Water St
Suite 1a
Arlington, MA 02476-4812

Mailing address

11 Water St
Suite 1a
Arlington, MA 02476-4812
Phone (781) 648-9700

Other identifiers 1

IdentifierTypeStateIssuer
9711635MedicaidMA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040812000708 MA Part B Supplier - Clinic/Group Practice 5395717920 Receives reassigned benefits from 17 practitioners
Practice locations: Arlington, MA

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
22D0698550Family Practice Group PC11 Water Street #1-a, Arlington, MA 02476Provider-performed microscopyOct 22, 2027

National Provider Directory

National Provider Directory

Locations

11 Water St
Ste 1A
Arlington, MA 02476
Phone (781) 648-9700

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279238400000",
    "number": "1801953849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 WATER ST",
            "address_2": "SUITE 1A",
            "city": "ARLINGTON",
            "state": "MA",
            "postal_code": "024764812",
            "telephone_number": "781-648-9700",
            "fax_number": "781-648-0234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 WATER ST",
            "address_2": "SUITE 1A",
            "city": "ARLINGTON",
            "state": "MA",
            "postal_code": "024764812",
            "telephone_number": "781-648-9700",
            "fax_number": "781-648-0234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PRACTICE GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2010-07-16",
        "status": "A",
        "authorized_official_last_name": "HILLERY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "781-648-9700"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9711635",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.