| Northeast Hospital Corporation | |
|
85 Herrick St Beverly Hospital Beverly MA 01915-1776 | |
| (978) 922-3000 | |
| (978) 921-7071 |
| Full Name | Northeast Hospital Corporation |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 85 Herrick St, Beverly, Massachusetts |
| Authorized Official Name and Position | Philip Cormier (CEO) |
| Authorized Official Contact | 9789223000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Hospital Corporation 85 Herrick St Beverly Hospital Beverly MA 01915-1776 Ph: (978) 922-3000 | Northeast Hospital Corporation 85 Herrick St Beverly Hospital Beverly MA 01915-1776 Ph: (978) 922-3000 |
| NPI Number | 1316917941 |
|---|---|
| Provider Enumeration Date | 01/25/2006 |
| Last Update Date | 09/02/2016 |
| Medicare PECOS PAC ID | 1153213202 |
|---|---|
| Medicare Enrollment ID | O20040721000148 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316917941 | NPI | - | NPPES |
| 1000039 | Medicaid | MA | |
| 2222003301 | Other | MA | BC HMO/PHO INPAT |
| 901790 | Other | MA | TUFTS PHO INPAT |
| 9343 | Other | MA | AETNA HMO |
| BEV2222003301 | Other | MA | HMO BLUE INPAT |
| S005394 | Other | MA | CHAMPUS |
| 2222003311 | Other | MA | BC HMO/PHO OUTPAT |
| 901790 | Other | MA | TUFTS MCR INPAT |
| 0007079 | Medicaid | MA | |
| 2222003301 | Other | MA | BC INDEM INPAT |
| 900385 | Other | MA | FIRST SENIORITY |
| 1202626 | Medicaid | MA | |
| 2222003311 | Other | MA | BC INDEM OUTPAT |
| 900082 | Other | MA | TUFTS MCR OUTPAT |
| 1000039 | Medicaid | MD | |
| 900082 | Other | MA | TUFTS PHO OUTPAT |
| 900385 | Other | MA | HARVARD PILGRIM HMO |
| BEV2222003311 | Other | MA | HMO BLUE OUTPAT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | V93D (Massachusetts) | Secondary |
| 282N00000X | General Acute Care Hospital | 15 (Massachusetts) | Primary |
| Provider Name | Kimberly A Markuns |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1689632507 PECOS PAC ID: 1254238777 Enrollment ID: I20031215000123 |
| Provider Name | Robert S Henriques |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508847898 PECOS PAC ID: 1254323124 Enrollment ID: I20040331001230 |
| Provider Name | S Lawson Derby |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1841215522 PECOS PAC ID: 7012808025 Enrollment ID: I20040421000210 |
| Provider Name | Steven A Gillespie |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588761019 PECOS PAC ID: 1557343522 Enrollment ID: I20040603000397 |
| Provider Name | Zorayda T Vidal Farino |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558341206 PECOS PAC ID: 5799768420 Enrollment ID: I20040611001110 |
| Provider Name | Gyorgy L Varai |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639117070 PECOS PAC ID: 6608850920 Enrollment ID: I20040615000966 |
| Provider Name | Canh P Vu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184693988 PECOS PAC ID: 0244201622 Enrollment ID: I20040802000586 |
| Provider Name | Fiona M Breslin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1942295902 PECOS PAC ID: 9830152842 Enrollment ID: I20041110000989 |
| Provider Name | Katherine K Miura |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801853007 PECOS PAC ID: 2961453584 Enrollment ID: I20050201000595 |
| Provider Name | Mauri R Cohen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093767857 PECOS PAC ID: 2163495292 Enrollment ID: I20050323001107 |
| Provider Name | Francis X Cleary |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1821014457 PECOS PAC ID: 2769438217 Enrollment ID: I20050328000696 |
| Provider Name | Kirsten A Malsnee |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306983507 PECOS PAC ID: 5294781456 Enrollment ID: I20050330000906 |
| Provider Name | Robert J Rokowski |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1144275801 PECOS PAC ID: 2668429663 Enrollment ID: I20050401000434 |
| Provider Name | Shamai A Grossman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205877834 PECOS PAC ID: 8022056167 Enrollment ID: I20050420000319 |
| Provider Name | Maura P Copeland |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184609307 PECOS PAC ID: 4981642600 Enrollment ID: I20050421001385 |
| Provider Name | Dominique A Rutteman |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1093826372 PECOS PAC ID: 0941241467 Enrollment ID: I20050516000247 |
| Provider Name | Karen F Jacobs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194800417 PECOS PAC ID: 1254372378 Enrollment ID: I20050519000242 |
| Provider Name | Lance A Larsen |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1144240789 PECOS PAC ID: 7810939790 Enrollment ID: I20050601000953 |
| Provider Name | Michael K Tibbles |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801878699 PECOS PAC ID: 2668408527 Enrollment ID: I20050712000661 |
| Provider Name | Barry I Ginsberg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184786402 PECOS PAC ID: 9739119736 Enrollment ID: I20050819000077 |
| Provider Name | Elizabeth A Soccorso |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1528167665 PECOS PAC ID: 3971535675 Enrollment ID: I20050901000870 |
| Provider Name | Jessica Stockman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437260999 PECOS PAC ID: 9032143441 Enrollment ID: I20050926000140 |
| Provider Name | Kevin J Ennis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508804725 PECOS PAC ID: 9234175860 Enrollment ID: I20051019000508 |
| Provider Name | David F Smail |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1679506802 PECOS PAC ID: 8527087386 Enrollment ID: I20051122000345 |
| Provider Name | Beatrice Szeto |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376580019 PECOS PAC ID: 6507874229 Enrollment ID: I20060322000409 |
| Provider Name | Amit Granot |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538186598 PECOS PAC ID: 8123036126 Enrollment ID: I20060403000490 |
| Provider Name | Vincent P Meoli |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215994728 PECOS PAC ID: 5395758403 Enrollment ID: I20060713000020 |
| Provider Name | Sanda S Aung |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679564108 PECOS PAC ID: 2163435504 Enrollment ID: I20060801000195 |
| Provider Name | Vittorio J Raho |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1023043353 PECOS PAC ID: 1658377551 Enrollment ID: I20061017000481 |
| Provider Name | Evelyn Resto |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780789107 PECOS PAC ID: 8022111434 Enrollment ID: I20070305000631 |
| Provider Name | Helene Hutchinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033324330 PECOS PAC ID: 8123113313 Enrollment ID: I20071003000210 |
| Provider Name | Corinna R Mcallon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336107929 PECOS PAC ID: 7618067935 Enrollment ID: I20071226000158 |
| Provider Name | Kimberly Y Willis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164601514 PECOS PAC ID: 5193801793 Enrollment ID: I20080324000373 |
| Provider Name | Alexander Doumas |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1770619363 PECOS PAC ID: 7012087067 Enrollment ID: I20080602000896 |
| Provider Name | Neelam V Desai |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1699864413 PECOS PAC ID: 6608942396 Enrollment ID: I20080903000508 |
| Provider Name | Soumya Ganapathy |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1093811648 PECOS PAC ID: 6709778459 Enrollment ID: I20090429000236 |
| Provider Name | Edward Loughery |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1033112610 PECOS PAC ID: 0840189627 Enrollment ID: I20090904000338 |
| Provider Name | Urrooj Rehman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205021862 PECOS PAC ID: 5991835548 Enrollment ID: I20100609000308 |
| Provider Name | Jeffrey Soderman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1841221082 PECOS PAC ID: 7315061272 Enrollment ID: I20100830000046 |
| Provider Name | Joshua Lerner |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1710184890 PECOS PAC ID: 1153445721 Enrollment ID: I20100903000008 |
| Provider Name | Deborah L Korik |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144359514 PECOS PAC ID: 0244354744 Enrollment ID: I20100907000461 |
| Provider Name | Kyan J Berger |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316919269 PECOS PAC ID: 6800088113 Enrollment ID: I20101005000867 |
| Provider Name | Tamar Lipof |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1447447123 PECOS PAC ID: 9739373689 Enrollment ID: I20101104000469 |
| Provider Name | Donald Pasquarello |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124066410 PECOS PAC ID: 7113115478 Enrollment ID: I20101230000666 |
| Provider Name | Elizabeth Shuman |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1114237419 PECOS PAC ID: 5496935280 Enrollment ID: I20110210001166 |
| Provider Name | Vivian Bennett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700960796 PECOS PAC ID: 3173705597 Enrollment ID: I20110307000617 |
| Provider Name | Amanda D Czuczman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609066653 PECOS PAC ID: 3476724006 Enrollment ID: I20110912000446 |
| Provider Name | Daniel Rollings Karlin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942434311 PECOS PAC ID: 5193997146 Enrollment ID: I20111017000455 |
| Provider Name | Satish C Vallabhaneni |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538205687 PECOS PAC ID: 5496928541 Enrollment ID: I20111104000554 |
| Provider Name | Janet L Schuchter |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1801984968 PECOS PAC ID: 1052586187 Enrollment ID: I20111219000451 |
| Provider Name | Steven P Larosa |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1811941180 PECOS PAC ID: 0840275681 Enrollment ID: I20121015000215 |
| Provider Name | Tanishia D Choice |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396904611 PECOS PAC ID: 1355528233 Enrollment ID: I20130313000239 |
| Provider Name | Irina Guryanova |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619925898 PECOS PAC ID: 7416956537 Enrollment ID: I20130514000544 |
| Provider Name | Amalanshu Jha |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1043487788 PECOS PAC ID: 1850416413 Enrollment ID: I20131202000323 |
| Provider Name | Munirih Yeshwant |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801038500 PECOS PAC ID: 8820255755 Enrollment ID: I20140326001367 |
| Provider Name | Karina Tamir |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770877144 PECOS PAC ID: 2264663780 Enrollment ID: I20140327000015 |
| Provider Name | Rechele L Jordow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689001059 PECOS PAC ID: 4789800251 Enrollment ID: I20140721000031 |
| Provider Name | Genny I Wolf |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659665909 PECOS PAC ID: 5092932780 Enrollment ID: I20140804000381 |
| Provider Name | Bradley Demeter |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1417243270 PECOS PAC ID: 3971739236 Enrollment ID: I20141126001712 |
| Provider Name | Linda Sinclair |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770840217 PECOS PAC ID: 8820309271 Enrollment ID: I20150625001963 |
| Provider Name | Kathryn A. Zioto |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114283108 PECOS PAC ID: 1951623545 Enrollment ID: I20160502001544 |
| Provider Name | Peter Severin Gill |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1831283175 PECOS PAC ID: 2668471160 Enrollment ID: I20160518000222 |
| Provider Name | James A Jenkins Ii |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235577313 PECOS PAC ID: 9830312909 Enrollment ID: I20160523001938 |
| Provider Name | Stephen M Tourjee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184985913 PECOS PAC ID: 6901024439 Enrollment ID: I20160531000946 |
| Provider Name | Prabakar Thyagarajan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033271010 PECOS PAC ID: 7810288891 Enrollment ID: I20160622001142 |
Atentiv Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 Cummings Ctr Ste 451c, Beverly, MA 01915 Phone: 508-954-0494 | |
North Shore Counseling Center Inc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 23 Broadway, Beverly, MA 01915 Phone: 978-922-2280 Fax: 978-927-1758 | |
Beacon Counseling Services Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 140 Elliott St Ste 5, Beverly, MA 01915 Phone: 978-473-1346 | |
Megan Grandon Licsw Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 65 Dodge St Unit C, North Beverly Plaza #1016, Beverly, MA 01915 Phone: 978-219-4119 | |
Dba Scott R. Olson Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 500 Cummings Center Suite 5350, North Shore Psychiatry Center, Beverly, MA 01915 Phone: 978-922-8600 Fax: 978-922-8601 | |
Clinical Solutions, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 Cummings Ctr, Suite 457 -j, Beverly, MA 01915 Phone: 617-955-9228 | |
Medical Psychology Center, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 100 Cummings Ctr, Suite 456j, Beverly, MA 01915 Phone: 978-921-4000 Fax: 978-921-7530 |