| South Boston Community Health Center Inc | |
|
409 W Broadway South Boston MA 02127-2245 | |
| (617) 269-7500 | |
| (617) 464-7512 |
| Full Name | South Boston Community Health Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 409 W Broadway, South Boston, Massachusetts |
| Authorized Official Name and Position | Akinola Ogungbadero (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6172697500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Boston Community Health Center Inc 409 W Broadway South Boston MA 02127-2245 Ph: (617) 269-7500 | South Boston Community Health Center Inc 409 W Broadway South Boston MA 02127-2245 Ph: (617) 269-7500 |
| NPI Number | 1669447413 |
|---|---|
| Provider Enumeration Date | 02/22/2006 |
| Last Update Date | 01/27/2020 |
| Medicare PECOS PAC ID | 2062487291 |
|---|---|
| Medicare Enrollment ID | O20040831000673 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669447413 | NPI | - | NPPES |
| CB9679 | Other | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
| Provider Name | Jeffrey F Markuns |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184698474 PECOS PAC ID: 2163328907 Enrollment ID: I20031211000295 |
| Provider Name | Tu Mai Tran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740338524 PECOS PAC ID: 9638075484 Enrollment ID: I20031211000337 |
| Provider Name | Cheryl A Mcsweeney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811976897 PECOS PAC ID: 8325934078 Enrollment ID: I20040227000573 |
| Provider Name | Kavitha Gazula |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710965074 PECOS PAC ID: 2567456387 Enrollment ID: I20040413001484 |
| Provider Name | Joseph Peppe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619941903 PECOS PAC ID: 2860487147 Enrollment ID: I20040416000540 |
| Provider Name | Deepa Jhaveri |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1477549350 PECOS PAC ID: 2769471259 Enrollment ID: I20040510001065 |
| Provider Name | Charles T Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134107436 PECOS PAC ID: 4183614654 Enrollment ID: I20040517000162 |
| Provider Name | Avra L Goldman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821064726 PECOS PAC ID: 1850381344 Enrollment ID: I20040517000304 |
| Provider Name | Christopher S Manasseh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407820673 PECOS PAC ID: 7113917634 Enrollment ID: I20040517000538 |
| Provider Name | Laura N Goldman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205800455 PECOS PAC ID: 5597755934 Enrollment ID: I20040517000749 |
| Provider Name | Christine D Odell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083681522 PECOS PAC ID: 4486644846 Enrollment ID: I20040517000838 |
| Provider Name | Nisha Thakrar |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1831163443 PECOS PAC ID: 6406837277 Enrollment ID: I20040527000251 |
| Provider Name | Rachel K Mott Keis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447239439 PECOS PAC ID: 7517943566 Enrollment ID: I20040629000731 |
| Provider Name | David M Gunther |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467426536 PECOS PAC ID: 9739167230 Enrollment ID: I20040712000256 |
| Provider Name | Aram Kaligian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912970591 PECOS PAC ID: 0941280044 Enrollment ID: I20040721000080 |
| Provider Name | Susannah Rowe |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1073509741 PECOS PAC ID: 1355312026 Enrollment ID: I20040804001896 |
| Provider Name | Meenakshi Kumar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417982513 PECOS PAC ID: 7810962172 Enrollment ID: I20040831000032 |
| Provider Name | Sheel J Saxena |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629041462 PECOS PAC ID: 9830158005 Enrollment ID: I20041005000518 |
| Provider Name | Glennon J O Grady |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174502140 PECOS PAC ID: 0042282378 Enrollment ID: I20041207000246 |
| Provider Name | Virginia M Fitzgerald |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1487628087 PECOS PAC ID: 8628029733 Enrollment ID: I20050207000419 |
| Provider Name | John L Berk |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1407831258 PECOS PAC ID: 6709825862 Enrollment ID: I20050427001350 |
| Provider Name | Robert B Saper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144294307 PECOS PAC ID: 2062452592 Enrollment ID: I20050504000713 |
| Provider Name | Pamela J Cattel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023081841 PECOS PAC ID: 6608819958 Enrollment ID: I20050607001006 |
| Provider Name | David C Harrison |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1801879200 PECOS PAC ID: 3476597725 Enrollment ID: I20050616001013 |
| Provider Name | Karin Leschly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013996099 PECOS PAC ID: 3274578745 Enrollment ID: I20050624000428 |
| Provider Name | Hong Thao N Thieu |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1982682076 PECOS PAC ID: 8628004504 Enrollment ID: I20050712000780 |
| Provider Name | Debbie Fuentes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639144074 PECOS PAC ID: 0244257590 Enrollment ID: I20051027000397 |
| Provider Name | Alison O Marshall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407994932 PECOS PAC ID: 1153345061 Enrollment ID: I20060118000888 |
| Provider Name | Mohamed A Mehssen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578536389 PECOS PAC ID: 6507874831 Enrollment ID: I20060329000152 |
| Provider Name | Douglas W Comeau |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1346382835 PECOS PAC ID: 2062513138 Enrollment ID: I20070719000827 |
| Provider Name | Alysia L Green |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1013124296 PECOS PAC ID: 6305938317 Enrollment ID: I20070822001047 |
| Provider Name | Evelyne Chiakpo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619942075 PECOS PAC ID: 4486661402 Enrollment ID: I20070912000555 |
| Provider Name | Lars E Reinhold |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578754578 PECOS PAC ID: 5698860419 Enrollment ID: I20071009000051 |
| Provider Name | Heather H Miselis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437349529 PECOS PAC ID: 5890881726 Enrollment ID: I20071023000499 |
| Provider Name | Judith R Darrow |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1205834496 PECOS PAC ID: 9032290234 Enrollment ID: I20080114000588 |
| Provider Name | Sheilah A Bernard |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1275518318 PECOS PAC ID: 8426130022 Enrollment ID: I20080204000476 |
| Provider Name | Clarissa B Foy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770755050 PECOS PAC ID: 0042398422 Enrollment ID: I20080425000155 |
| Provider Name | Thomas C Hines |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235103219 PECOS PAC ID: 2860562097 Enrollment ID: I20080530000524 |
| Provider Name | Emmy Graber |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1245353366 PECOS PAC ID: 3779656129 Enrollment ID: I20080718000319 |
| Provider Name | Jennifer L Pfau |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134263502 PECOS PAC ID: 3375611858 Enrollment ID: I20081010000325 |
| Provider Name | Katherine A Gergen Barnett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023209129 PECOS PAC ID: 7618036047 Enrollment ID: I20081030000230 |
| Provider Name | Judith Yen Lin Colclough |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700839859 PECOS PAC ID: 3678585460 Enrollment ID: I20081202000902 |
| Provider Name | Uri Avissar |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1134296064 PECOS PAC ID: 9234290289 Enrollment ID: I20081209000366 |
| Provider Name | Michael K Lichtman |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1043411473 PECOS PAC ID: 7416011200 Enrollment ID: I20090122000422 |
| Provider Name | Suru Lin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316112162 PECOS PAC ID: 3678626082 Enrollment ID: I20090803000469 |
| Provider Name | Deborah E Dreyfus |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174563134 PECOS PAC ID: 9335294651 Enrollment ID: I20090909000591 |
| Provider Name | Alissa Robyn Dangel |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1235353475 PECOS PAC ID: 0143376301 Enrollment ID: I20090914000437 |
| Provider Name | Cynthia L Sershen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366614497 PECOS PAC ID: 7113064437 Enrollment ID: I20091019000606 |
| Provider Name | Meng Meng Xu |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1356598080 PECOS PAC ID: 7810063054 Enrollment ID: I20091112000280 |
| Provider Name | Megan Chapman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154654556 PECOS PAC ID: 5799824223 Enrollment ID: I20091123000414 |
| Provider Name | Feng Wang |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1033181656 PECOS PAC ID: 2961526157 Enrollment ID: I20100824001257 |
| Provider Name | Anne Theresa Dwyer-wilmer |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1619170255 PECOS PAC ID: 5799978946 Enrollment ID: I20101020000163 |
| Provider Name | Lana Habash |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316911399 PECOS PAC ID: 2264620731 Enrollment ID: I20101228000344 |
| Provider Name | Elena Z Biffi |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1902110026 PECOS PAC ID: 4789871807 Enrollment ID: I20110916000320 |
| Provider Name | Kathryn M Schoch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124262753 PECOS PAC ID: 2062670805 Enrollment ID: I20120224000007 |
| Provider Name | Kathleen M Joyce |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1932161890 PECOS PAC ID: 4486813482 Enrollment ID: I20120312000225 |
| Provider Name | Emily Hames |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689814741 PECOS PAC ID: 7012172539 Enrollment ID: I20120709000506 |
| Provider Name | Christina Lam |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1194003731 PECOS PAC ID: 8820245343 Enrollment ID: I20120905000517 |
| Provider Name | Amy Chen |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1164681573 PECOS PAC ID: 4688822240 Enrollment ID: I20120924000685 |
| Provider Name | Scott P Simmons |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922247220 PECOS PAC ID: 7214188911 Enrollment ID: I20121106000138 |
| Provider Name | Aileen M Richmond |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760619928 PECOS PAC ID: 1355593070 Enrollment ID: I20121204000151 |
| Provider Name | Sarah Sloan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770719460 PECOS PAC ID: 2860644598 Enrollment ID: I20121204000209 |
| Provider Name | Kuon S. Lo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730341686 PECOS PAC ID: 8123282050 Enrollment ID: I20121217000208 |
| Provider Name | David Eric Negron |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1285623694 PECOS PAC ID: 6305059247 Enrollment ID: I20130709000838 |
| Provider Name | Crystal M Lewandowski |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1740621069 PECOS PAC ID: 4789819350 Enrollment ID: I20131107000576 |
| Provider Name | Kathleen R Chung |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083938518 PECOS PAC ID: 4587809298 Enrollment ID: I20131108000778 |
| Provider Name | Sarah Palmer Hale |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306008149 PECOS PAC ID: 0446421093 Enrollment ID: I20141111001052 |
| Provider Name | Afi Mansa Semenya |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861786972 PECOS PAC ID: 0143542233 Enrollment ID: I20141126001382 |
| Provider Name | Jaime Skrekas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255603197 PECOS PAC ID: 0143544569 Enrollment ID: I20150113001394 |
| Provider Name | Alexis G Malkin |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1932355187 PECOS PAC ID: 1254483803 Enrollment ID: I20150729010288 |
| Provider Name | Zoe E Kiefer |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1871888180 PECOS PAC ID: 7517272974 Enrollment ID: I20150813010445 |
| Provider Name | Elizabeth T Corridan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518373752 PECOS PAC ID: 7315252566 Enrollment ID: I20150817001880 |
| Provider Name | Thomas Andrea |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1669881041 PECOS PAC ID: 8921315714 Enrollment ID: I20150910002015 |
| Provider Name | Jennifer L Trieu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992026777 PECOS PAC ID: 3173764271 Enrollment ID: I20151117000145 |
| Provider Name | Lidya Helen Wlasiuk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003175910 PECOS PAC ID: 7214169556 Enrollment ID: I20151118000900 |
| Provider Name | Kim Fang Yuh Chiang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700145414 PECOS PAC ID: 4183856701 Enrollment ID: I20151210000658 |
| Provider Name | Laura Falkiewicz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801203799 PECOS PAC ID: 0143519850 Enrollment ID: I20160519001718 |
| Provider Name | Jean S. Mcgee |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1306102322 PECOS PAC ID: 5799917993 Enrollment ID: I20160901001977 |
| Provider Name | Mekkin E Lynch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245674985 PECOS PAC ID: 4688952781 Enrollment ID: I20161025000315 |
| Provider Name | Jeffrey K Ho |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1124480520 PECOS PAC ID: 2860771516 Enrollment ID: I20161121000637 |
| Provider Name | Joseph Edward Kane |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1568846467 PECOS PAC ID: 3678853702 Enrollment ID: I20161207002189 |
| Provider Name | Kevin Andrew Coughlin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750727749 PECOS PAC ID: 9133361421 Enrollment ID: I20170224000293 |
| Provider Name | Marielle C Baldwin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396164877 PECOS PAC ID: 5193943074 Enrollment ID: I20170828002806 |
| Provider Name | Elizabeth A Doran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255741856 PECOS PAC ID: 6103044094 Enrollment ID: I20170925000042 |
| Provider Name | Patrick Lee |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1518370535 PECOS PAC ID: 2365669967 Enrollment ID: I20171116000247 |
| Provider Name | Lisa Yao Shen |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1881915148 PECOS PAC ID: 2163778770 Enrollment ID: I20180711002354 |
| Provider Name | Karen R Tenner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316324460 PECOS PAC ID: 0446567945 Enrollment ID: I20180829004446 |
| Provider Name | Katherine L Zeitler |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518351931 PECOS PAC ID: 8426365537 Enrollment ID: I20181105000306 |
| Provider Name | Veronica Lynn Hecht |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437633401 PECOS PAC ID: 5799028908 Enrollment ID: I20190509002103 |
| Provider Name | Alexandra R. Pipilas |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1023470416 PECOS PAC ID: 7517252869 Enrollment ID: I20190520000703 |
| Provider Name | Keith Howard Mantel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356351118 PECOS PAC ID: 9638171846 Enrollment ID: I20190605000645 |
| Provider Name | Deanne Wimsatt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861995755 PECOS PAC ID: 0345576252 Enrollment ID: I20190731000489 |
| Provider Name | Adi Rattner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235552415 PECOS PAC ID: 3173818572 Enrollment ID: I20190806003105 |
| Provider Name | Mary Mcpherson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548706187 PECOS PAC ID: 9537490065 Enrollment ID: I20191014001928 |
| Provider Name | Kelly St. Bernard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215411749 PECOS PAC ID: 4587996434 Enrollment ID: I20191028000653 |
| Provider Name | Elyse M Riegel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699325902 PECOS PAC ID: 0749512168 Enrollment ID: I20191104001894 |
| Provider Name | Victoria C Rines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225686124 PECOS PAC ID: 3779915350 Enrollment ID: I20191120001069 |
| Provider Name | Lakedra S. Pam |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1992026983 PECOS PAC ID: 8022333277 Enrollment ID: I20200827001812 |
| Provider Name | Bilal Fawaz |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1710336722 PECOS PAC ID: 3375821317 Enrollment ID: I20201002002944 |
| Provider Name | Joan Savage |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699206565 PECOS PAC ID: 9436420361 Enrollment ID: I20201105000333 |
| Provider Name | Isabella Buzzo Bellon Brout |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306377049 PECOS PAC ID: 7416224969 Enrollment ID: I20201106000645 |
| Provider Name | Sean Sanker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598113391 PECOS PAC ID: 0244640811 Enrollment ID: I20201110002777 |
| Provider Name | Alexandra Belcher-obejero-paz |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1952798704 PECOS PAC ID: 2062727290 Enrollment ID: I20201208000554 |
| Provider Name | Erica Rollock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326499559 PECOS PAC ID: 2163835307 Enrollment ID: I20210108000209 |
| Provider Name | Cheralyn Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568871549 PECOS PAC ID: 5294149548 Enrollment ID: I20210127001568 |
| Provider Name | Ashish Verma |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1770967143 PECOS PAC ID: 9032492533 Enrollment ID: I20210715000244 |
| Provider Name | Amelia Fisher |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1588920284 PECOS PAC ID: 6800190331 Enrollment ID: I20210803002588 |
| Provider Name | Asuma Tanaka |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093249997 PECOS PAC ID: 7618214701 Enrollment ID: I20210804001249 |
| Provider Name | Carolyn M Arnold |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093104408 PECOS PAC ID: 6800146333 Enrollment ID: I20210806000529 |
| Provider Name | Christina Curtis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689152951 PECOS PAC ID: 2163826322 Enrollment ID: I20210810002077 |
| Provider Name | Heather Ross |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033614938 PECOS PAC ID: 9436408911 Enrollment ID: I20210826003525 |
| Provider Name | Thomas J Schuch |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1649430323 PECOS PAC ID: 1658776745 Enrollment ID: I20210827001872 |
| Provider Name | Emma Pitoniak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053082677 PECOS PAC ID: 1557759495 Enrollment ID: I20211027000492 |
| Provider Name | Tak-man Kimberly Fung |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1962011601 PECOS PAC ID: 1153711700 Enrollment ID: I20211214001511 |
| Provider Name | Morgan Larrabee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366117244 PECOS PAC ID: 6608268974 Enrollment ID: I20220118001716 |
| Provider Name | Adom L Fermanian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437725694 PECOS PAC ID: 0840684841 Enrollment ID: I20220308000168 |
| Provider Name | Amy Christine Sickinger |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1477209278 PECOS PAC ID: 7214315100 Enrollment ID: I20220606000982 |
| Provider Name | Alyssa Robinson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1699234757 PECOS PAC ID: 2567795156 Enrollment ID: I20220628002785 |
| Provider Name | Sarah Elizabeth Brenner |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1922615160 PECOS PAC ID: 7911373378 Enrollment ID: I20221026002296 |
| Provider Name | Jessica Salak |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1871778936 PECOS PAC ID: 4688741440 Enrollment ID: I20221207002185 |
| Provider Name | Sophia Louise Harden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306567821 PECOS PAC ID: 6204206535 Enrollment ID: I20230103001959 |
| Provider Name | Ryan J Narciso |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1093275273 PECOS PAC ID: 5597099317 Enrollment ID: I20230614003671 |
| Provider Name | Anh V Bui |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1891363644 PECOS PAC ID: 3476930454 Enrollment ID: I20230830002958 |
| Provider Name | James Abraham Allentuck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578282448 PECOS PAC ID: 1254787146 Enrollment ID: I20231030000998 |
| Provider Name | Shannon Bridget Lydon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467186890 PECOS PAC ID: 9537517420 Enrollment ID: I20231204001433 |
| Provider Name | Kathryn Rezuke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518613421 PECOS PAC ID: 5496105272 Enrollment ID: I20231219003572 |
Weintraub Geriatric Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 804 E 7th St, South Boston, MA 02127 Phone: 617-268-8968 | |
South Boston Community Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 409 W Broadway, South Boston, MA 02127 Phone: 617-269-7500 Fax: 617-464-7581 | |
South Boston Community Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 409 W Broadway, South Boston, MA 02127 Phone: 617-269-7500 | |
Harbor Family Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 32 Devine Way, Harbor Family Health Center, South Boston, MA 02127 Phone: 617-269-0312 | |
South Boston Community Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 409 W Broadway, South Boston, MA 02127 Phone: 617-269-7500 Fax: 617-464-7581 | |
Gavin Foundation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 49 L St, South Boston, MA 02127 Phone: 617-268-5000 Fax: 617-268-5008 |