FENWAY COMMUNITY HEALTH CENTER, INC (NPI# 1548589047) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548589047 |
| Entity Type | Organization |
| Organization Name | FENWAY COMMUNITY HEALTH CENTER, INC |
| Other Organization Name | SIDNEY BORUM JR. HEALTH CENTER OF FENWAY HEALTH |
| Practice Address |
75 Kneeland St 2nd Floor Boston MA 02111-1901 |
| Mailing Address |
1340 Boylston St Boston MA 02215-4302 |
| Practice Telephone | 6174578140 |
| Practice Fax Number | 6174578141 |
| Mailing Telephone | 6179276173 |
| Mailing Fax Number | 6179275410 |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2013-09-11 |
| Authorized Official Name | MR. JEFFREY M LIEBERMAN (VP FINANACE & ADMINISTRATION) |
| Authorized Official Telephone | 6179276173 |
| Is Organization Subpart | Y |
| Parent Organization Name | FENWAY COMMUNITY HEALTH CENTER INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
4519 | MA | Ambulatory Health Care Facilities |
| Y | 261QC1500X |
Clinic/Center Specialization: Community Health |
4519 | MA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 110024430F | 05 |
| Other Name | Type Code |
|---|---|
| Sidney Borum Jr. Health Center of Fenway Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982995197 | Fenway Community Health Center, Inc | Clinic/Center | 142 Berkeley St, Boston, MA 02116-5100 | 2011-04-21 |
| 1073744611 | Fenway Community Health Center, Inc | Clinic/Center | 1340 Boylston St, 6th Floor, Boston, MA 02215-4302 | 2009-07-30 |
| 1275647505 | Fenway Community Health Center, Inc | Pharmacist | 1340 Boylston St, Boston, MA 02215-4302 | 2006-08-17 |
| 1003804725 | Fenway Community Health Center, Inc | Clinic/Center | 1340 Boylston St, Boston, MA 02215-4302 | 2005-10-06 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | FENWAY COMMUNITY HEALTH CENTER, INC. | 1340 Boylston St, Boston, MA 02215-4302 |
| Street Address |
75 KNEELAND ST 2ND FLOOR |
| City | BOSTON |
| State | MA |
| Zip Code | 02111-1901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841272846 | Gregory Fenton | Internal Medicine | 75 Kneeland St, Suite 201, Boston, MA 02111-1901 | 2005-11-16 |
| 1457996563 | Sean James Borger | Social Worker | 75 Kneeland St, Boston, MA 02111-1901 | 2019-11-12 |
| 1811531965 | Wayne Preston Pearson Jr. | Social Worker | 75 Kneeland St, Boston, MA 02111-1901 | 2019-11-01 |
| 1811479900 | Katherine Luciano | Social Worker | 75 Kneeland St, Boston, MA 02111-1901 | 2018-09-05 |
| 1972982577 | Samantha Hodgins | Registered Nurse | 75 Kneeland St, Boston, MA 02111-1901 | 2015-05-28 |
| 1497012405 | Rachel Kahn | Counselor | 75 Kneeland St, #201, Boston, MA 02111-1901 | 2012-04-13 |
| 1295046076 | Karla Hoxha Brown | Nurse Practitioner | 75 Kneeland St, Suite 201, Boston, MA 02111-1901 | 2010-06-28 |
| 1417139239 | Greater Boston Chinese Golden Age Center, Inc. | Case Management | 75 Kneeland St, Suite 204, Boston, MA 02111-1901 | 2007-12-04 |
| 1750405262 | Midtown Home Health Services, Inc. | Home Health | 75 Kneeland St, Suite 204, Boston, MA 02111-1901 | 2007-03-19 |
| 1427068873 | Ralph Gilliland Vetters | Pediatrics | 75 Kneeland St, Suite 201, Boston, MA 02111-1901 | 2006-08-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689271397 | Maximilian Richert | Counselor | 25 Kingston St, 4r, Boston, MA 02111 | 2020-10-06 |
| 1558978957 | Tien-hsin Chang | Student in an Organized Health Care Education/Training Program | 1 Kneeland Street (tufts University School of Dental Me, Boston, MA 02111 | 2020-09-29 |
| 1548883465 | Elizabeth Carter Stapleton | Dentist | Tufts School of Dental Medicine: Dept of Orthodontics, 1 Kneeland Street, Boston, MA 02111 | 2020-05-27 |
| 1932729597 | Jacob Joseph Kosarchuk | Neurological Surgery | 800 Washington Street, Proger 7, Boston, MA 02111 | 2020-04-23 |
| 1164051868 | Daniele Abela | Surgery | 860 Washington Street, South Building, 4th Floor, Boston, MA 02111 | 2020-04-04 |
| 1184265258 | Jade Orthodontics | Dentist | 30 Kneeland St, Suite 301, Boston, MA 02111 | 2019-09-30 |
| 1932753639 | Loukia Kamille Danaf | Student in an Organized Health Care Education/Training Program | 1 Kneeland Street, Tufts University School of Dental Me, Boston, MA 02111 | 2019-07-31 |
| 1033771944 | Faris Khalifa | Student in an Organized Health Care Education/Training Program | 1 Kneeland Street, 5th Floor, Boston, MA 02111 | 2019-07-01 |
| 1609437276 | Blair Hanna Ray Farbstein | Student in an Organized Health Care Education/Training Program | 1 Kneeland Street, 3rd Floor, Boston, MA 02111 | 2019-06-25 |
| 1821658709 | Jennifer Drummond | Internal Medicine | 800 Washington St. Gme Office, Boston, MA 02111 | 2019-06-13 |
| Find all providers in zip 02111 | ||||
| Taxonomy Code | 261QC1500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Community Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811490790 | Trustees of Tufts College | Clinic/Center | 200 Harrison Ave Fl 2, Boston, MA 02111 | 2018-03-16 |
| 1982995197 | Fenway Community Health Center, Inc | Clinic/Center | 142 Berkeley St, Boston, MA 02116-5100 | 2011-04-21 |
| 1457653537 | South Cove Community Health Center | Clinic/Center | 885 Washington Street, Boston, MA 02111-1415 | 2010-11-23 |
| 1477884476 | Joseph William Ferullo | Clinic/Center | 179 Longwood Ave, Boston, MA 02115-5804 | 2010-01-15 |
| 1720242936 | Tam Medical Associates | Clinic/Center | 200 Lincoln St, 301, Boston, MA 02111-2418 | 2008-07-16 |
| 1235242462 | North End Community Health Center | Clinic/Center | 332 Hanover St, Boston, MA 02113-1901 | 2006-08-15 |
| 1629095674 | North End Community Health Center | Clinic/Center | 332 Hanover St, Boston, MA 02113-1901 | 2006-07-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083171805 | Community Health Center of Cape Cod, Inc. | Clinic/Center | 115 Scranton Ave, Falmouth, MA 02540-3560 | 2019-02-28 |
| 1073993937 | Greater New Bedford Community Health Center, Inc. | Clinic/Center | 135 Marion Rd, Wareham, MA 02571-1423 | 2015-06-05 |
| 1619369022 | Melissa Quast | Clinic/Center | 151 Run Hill Rd, Brewster, MA 02631-2374 | 2015-02-22 |
| 1992001457 | Mashpee Service Unit/indian Health Service | Clinic/Center | 483 Great Neck Road South, Building 002-health Clinic, Mashpee, MA 02649 | 2011-02-01 |
| 1407086937 | Springfield Dept of Health & Human Services | Clinic/Center | 769 Worthington Street, Hsh Dental Clinic, Springfeld, MA 01105-1112 | 2009-07-17 |
| 1619143500 | Lowell General Hospital | Clinic/Center | 295 Varnum Ave Rm 75, Lowell, MA 01854-2134 | 2008-05-01 |
| 1891816930 | Sunrise-amanecer Inc. | Clinic/Center | 19 Milford St, Springfield, MA 01107-1332 | 2007-04-03 |
| 1033257522 | Lemuel Shattuck Hosp | Clinic/Center | 9 Brewer St, Jamaica Plain, MA 02130-4032 | 2007-02-05 |
| 1932266533 | Roxbury Comprehensive Community Health Center, Inc. | Clinic/Center | 435 Warren St, Roxbury, MA 02119-1833 | 2007-01-02 |
| 1649293028 | Community Healthlink Inc | Clinic/Center | 12 Queen Street, Worcester, MA 01610 | 2006-07-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.