NPIMap

Organization Active NPI

Harvard Street Neighborhood Health Center Inc

Doing business as Harvard Street Neighborhood Health Center

  • Clinic/Center
  • Dorchester, MA
National Provider Identifier
1902954449
Registry record updated Mar 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
HARVARD STREET NEIGHBORHOOD HEALTH CENTER INC
Doing business as
Harvard Street Neighborhood Health Center
Practice address
632 Blue Hill Avenue
Dorchester, MA 02121
Phone
(617) 822-5520
Fax
(617) 282-1450
NPI assigned
Jan 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2014

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

Authorized official

Name
Mr. Charles A. Murphy
Title
President/Ceo
Phone
(617) 825-3400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Clinic Pharmacy 3336C0002X 16544 MA

Addresses

Primary practice location

632 Blue Hill Avenue
Dorchester, MA 02121

Mailing address

632 Blue Hill Avenue
Dorchester, MA 02121
Phone (617) 822-5520

Other identifiers 3

IdentifierTypeStateIssuer
2229121OtherNCPDP PROVIDER IDENTIFICATION NUMBER
110027894BMedicaidMA
1305409MedicaidMA

Other names 1

  • HARVARD STREET NEIGHBORHOOD HEALTH CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110603000044 MA Part A Provider - Federally Qualified Health Center (FQHC) 0840261988 Practice locations: Dorchester, MA
O20150106000713 MA Part B Supplier - Clinic/Group Practice 0840261988 Receives reassigned benefits from 7 practitioners
Practice locations: Boston, MA; Dorchester, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902954449. Details of each certification follow.

Federally qualified health center certification: CCN 221823

Legal name
HARVARD STREET NEIGHBORHOOD HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 26, 1993
Last certification
Oct 26, 1993
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1992 in MA
Enrollment address
632 Blue Hill Ave
Dorchester, MA 21213213

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Paul Josephs Individual Corporate DirectorBoard Member Oct 1, 2014
Charles Minor Individual Corporate Director Jan 1, 2017
Kai Phillip Individual Corporate Director Jan 9, 2020
Eileen Kenner Individual Corporate DirectorBoard Member Oct 1, 2011
Diana Rodriguez Individual W-2 Managing Employee Oct 18, 2021
Charles a Murphy Individual Corporate OfficerPresident and Ceo Dec 2, 2013
Jocelyn a Carter Individual Corporate DirectorBoard Member Oct 1, 2014
Bonnie Brathwaite Individual Corporate DirectorBoard Member Mar 31, 2011
Jessica Darosa Individual Corporate DirectorDirector of Operations Oct 18, 2021
Brian S Shelly Individual Corporate DirectorBoard Member Oct 1, 2010
Bria Gadsden Individual Corporate Director Jan 1, 2017
James R Cote Individual Corporate DirectorBoard Member Oct 1, 2011
Laurita Kaigler-Crawlie Individual Corporate Director Jan 1, 2017

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395100800000",
    "number": "1902954449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "632 BLUE HILL AVENUE",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "02121",
            "telephone_number": "617-822-5520",
            "fax_number": "617-282-1450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "632 BLUE HILL AVENUE",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "02121",
            "telephone_number": "617-822-5520",
            "fax_number": "617-282-1450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARVARD STREET NEIGHBORHOOD HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2014-03-18",
        "status": "A",
        "authorized_official_last_name": "MURPHY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "617-825-3400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "MA",
            "license": "16544",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2229121",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110027894B",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1305409",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HARVARD STREET NEIGHBORHOOD HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dorchester, MA

Sources for this page

Verify at the official NPI Registry.