NPIMap

Organization Active NPI

Southeastern Psychiatric Assoc

  • Psychiatry Physician
  • Randolph, MA
National Provider Identifier
1891771267
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SOUTHEASTERN PSYCHIATRIC ASSOC
Practice address
1093 N Main St
Randolph, MA 02368
Phone
(781) 963-7775
Fax
(781) 963-7776
NPI assigned
Dec 19, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Dean Solomon, MDNPI 1588641641
Title
President
Phone
(781) 963-7775

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X MA Primary

Addresses

Primary practice location

1093 N Main St
Randolph, MA 02368

Mailing address

1093 N Main St
Randolph, MA 02368
Phone (781) 963-7775

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050526000818 MA Part B Supplier - Clinic/Group Practice 4486696614 Receives reassigned benefits from 15 practitioners
Practice locations: Randolph, MA

National Provider Directory

National Provider Directory

Locations

1093 N Main St
Ste 1B
Randolph, MA 02368
Phone (781) 963-7775

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891771267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1093 N MAIN ST",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "02368",
            "telephone_number": "781-963-7775",
            "fax_number": "781-963-7776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1093 N MAIN ST",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "02368",
            "telephone_number": "781-963-7775",
            "fax_number": "781-963-7776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN PSYCHIATRIC ASSOC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SOLOMON",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-963-7775",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Randolph, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.