Natick Sports and Racquet Club

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LDN1011 Issued in MA

Legal business name

NATICK SPORTS AND RACQUET CLUB

Practice address

203 Oak St
Longfellow Sports Club
Natick, MA 01760-1306

Phone

(508) 653-4633

Fax

(508) 650-4986

NPI assigned

Nov 19, 2006

Organization subpart

No

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

Authorized official

Name

Miss Jane Polley, M.S., R.D., LDNNPI 1124192505

Title

Dietitian

Phone

(508) 653-4633

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Longfellow Sports Club Doing business as

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Practitioners 2

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

• Jane Frances Polley, RD, LDN

  • Registered Dietitian
  • Natick, MA
  • NPI 1124192505
  Medicare reassignment Authorized official
• Janna Yamron, M,S,. R.D., L.D.N.

  • Registered Dietitian
  • Wayland, MA
  • NPI 1093901563
  Medicare reassignment

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

{
    "created_epoch": "1163894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972677326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 OAK ST",
            "address_2": "LONGFELLOW SPORTS CLUB",
            "city": "NATICK",
            "state": "MA",
            "postal_code": "017601306",
            "telephone_number": "508-653-4633",
            "fax_number": "508-650-4986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 OAK ST",
            "address_2": "LONGFELLOW SPORTS CLUB",
            "city": "NATICK",
            "state": "MA",
            "postal_code": "017601306",
            "telephone_number": "508-653-4633",
            "fax_number": "508-650-4986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATICK SPORTS AND RACQUET CLUB",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POLLEY",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "DIETITIAN",
        "authorized_official_telephone_number": "508-653-4633",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "M.S., R.D., LDN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": "MA",
            "license": "LDN1011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "6300209",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5582051",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM HEALTH",
            "identifier": "39410",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "763282",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "LD0022",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Longfellow Sports Club",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Natick Eye Holdings, LLC
• Natick Family Dental PC
• Natick Family Eye Care PC
• Natick Family Pharmacy Inc
• Natick General Practice P C
• Natick Surgery Center, LLC
• Natick Surgical Associates Inc.
• Natick Visiting Nurse Assn
• NE Hand - Concord LLC
• Denise Nelken, PA

• Registered Dietitian in Natick, MA
• Providers in Natick, MA by specialty
• Registered Dietitian in Massachusetts

• 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.