NPIMap

Organization Active NPI

Gastroenterology Affiliates of Southeastern Massachusetts, PC

  • Gastroenterology Physician
  • Brockton, MA
National Provider Identifier
1891761862
Registry record updated May 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
GASTROENTEROLOGY AFFILIATES OF SOUTHEASTERN MASSACHUSETTS, PC
Practice address
1 Pearl St
Suite 1200
Brockton, MA 02301-2864
Phone
(508) 588-3174
Fax
(508) 588-3179
NPI assigned
Feb 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2011

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

Authorized official

Name
Joel Soloman
Title
President of Corporation
Phone
(508) 588-3174

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

1 Pearl St
Suite 1200
Brockton, MA 02301-2864

Mailing address

1 Pearl St
Suite 1200
Brockton, MA 02301-2864
Phone (508) 588-3174

Other names 1

  • Rheumatology & Gastroenterology Assoc PC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050614001023 MA Part B Supplier - Clinic/Group Practice 5193769842 Receives reassigned benefits from 6 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
22D1018894Gastroenterology Affiliates of Southeastern1 Pearl Street, Brockton, MA 02301Certificate of waiverNov 3, 2027

National Provider Directory

National Provider Directory

Locations

1 Pearl St
Ste 2700
Brockton, MA 02301
Phone (508) 584-4104

Practitioners & affiliated clinicians

Practitioners 12

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": "1141084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305504000000",
    "number": "1891761862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PEARL ST",
            "address_2": "SUITE 1200",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023012864",
            "telephone_number": "508-588-3174",
            "fax_number": "508-588-3179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PEARL ST",
            "address_2": "SUITE 1200",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023012864",
            "telephone_number": "508-588-3174",
            "fax_number": "508-588-3179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROENTEROLOGY AFFILIATES OF SOUTHEASTERN MASSACHUSETTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-28",
        "last_updated": "2011-05-16",
        "status": "A",
        "authorized_official_last_name": "SOLOMAN",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "PRESIDENT OF CORPORATION",
        "authorized_official_telephone_number": "508-588-3174"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rheumatology & Gastroenterology Assoc PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 May 16, 2011; 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.