NPIMap

Organization Active NPI

Bethel Medical Group PC

  • Family Medicine Physician
  • Brockton, MA
National Provider Identifier
1861607558
Registry record updated Apr 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BETHEL MEDICAL GROUP PC
Practice address
111 Torrey St
Brockton, MA 02301-4800
Phone
(508) 588-1200
Fax
(508) 941-0497
NPI assigned
May 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2016

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

Authorized official

Name
Dr. Douglas R Grogan, M.D.
Title
Ceo
Phone
(508) 588-1200

Specialties & licenses 1

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

Addresses

Primary practice location

111 Torrey St
Brockton, MA 02301-4800

Mailing address

PO Box 848889
Boston, MA 02284-8889
Phone (508) 588-1200

Other identifiers 1

IdentifierTypeStateIssuer
9780629MedicaidMA

Other names 1

  • Bethel Medical Group PC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040121000327 MA Part B Supplier - Clinic/Group Practice 4688576721 Receives reassigned benefits from 5 practitioners
Practice locations: Brockton, 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
22D0080387Bethel Medical Group111 Torrey St, Brockton, MA 02301Certificate of waiverMar 8, 2028

National Provider Directory

National Provider Directory
Tax ID family
Bethel Medical2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

111 Torrey St
Brockton, MA 02301
Phone (508) 584-5190

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/111/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459728000000",
    "number": "1861607558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 848889",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022848889",
            "telephone_number": "508-588-1200",
            "fax_number": "508-941-0497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 TORREY ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023014800",
            "telephone_number": "508-588-1200",
            "fax_number": "508-941-0497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHEL MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2016-04-04",
        "status": "A",
        "authorized_official_last_name": "GROGAN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "508-588-1200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "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": "9780629",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bethel Medical Group PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; 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.