NPIMap

Organization Active NPI

Preventive Medicine Associates

  • Addiction Medicine (Family Medicine) Physician
  • Brighton, MA
National Provider Identifier
1962705251
Registry record updated Dec 8, 2010
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Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
Legal business name
PREVENTIVE MEDICINE ASSOCIATES
Practice address
9 Henshaw St
Brighton, MA 02135-2905
Phone
(617) 782-5800
Fax
(617) 782-5801
NPI assigned
Dec 8, 2010
Organization subpart
Yes
Parent organization
PREVENTIVE MEDICINE ASSOCIATESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 8, 2010

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

Authorized official

Name
Mary J Delong, MM, RHIA
Title
Credentialing Manager
Phone
(413) 222-7711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X Primary

Addresses

Primary practice location

9 Henshaw St
Brighton, MA 02135-2905

Mailing address

9 Henshaw St
Brighton, MA 02135-2905
Phone (617) 782-5800

Other names 1

  • Brighton Family Practice Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Springfield International Health Center29 organizations share this tax ID, including this one
Part of
Springfield International Health Center

Other organizations with this tax ID 28

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

View all 28

Locations

9 Henshaw St
Brighton, MA 02135
Phone (617) 903-3538

NPI Registry JSON

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

{
    "created_epoch": "1291766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291766400000",
    "number": "1962705251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 HENSHAW ST",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021352905",
            "telephone_number": "617-782-5800",
            "fax_number": "617-782-5801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 HENSHAW ST",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021352905",
            "telephone_number": "617-782-5800",
            "fax_number": "617-782-5801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVENTIVE MEDICINE ASSOCIATES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREVENTIVE MEDICINE ASSOCIATES",
        "enumeration_date": "2010-12-08",
        "last_updated": "2010-12-08",
        "status": "A",
        "authorized_official_last_name": "DELONG",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "413-222-7711",
        "authorized_official_credential": "MM, RHIA"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brighton Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brighton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.