PASSPORT HEALTH HOLDINGS, LLC (NPI# 1659912533) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659912533 |
| Entity Type | Organization |
| Organization Name | PASSPORT HEALTH HOLDINGS, LLC |
| Practice Address |
111 Williard Street Suite Gc Quincy MA 02169-1200 |
| Mailing Address |
8324 E Hartford Drive Suite 200 Scottsdale AZ 85255-7801 |
| Practice Telephone | 8773588648 |
| Practice Fax Number | 8778776875 |
| Mailing Telephone | 8773588648 |
| Mailing Fax Number | 8778776875 |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2019-10-02 |
| Authorized Official Name | MR. DOUG SHACKELL (DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 4806469024 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2083P0901X |
Preventive Medicine Specialization: Public Health & General Preventive Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Passport Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336793843 | Passport Health Holdings, LLC | Community Health Worker | 545 Mainstream Drvie, Suite 401, Nashville, TN 37228-1231 | 2019-08-01 |
| 1093369597 | Passport Health Holdings, LLC | Community Health Worker | 901 E Saint Louis Street, Suite 107, Springfield, MO 65806-2574 | 2019-08-01 |
| 1801440318 | Passport Health Holdings, LLC | Community Health Worker | 5330 North Oak Trafficway, Suite 105, Kansas City, MO 64118-4600 | 2019-08-01 |
| 1902450406 | Passport Health Holdings, LLC | Community Health Worker | 345 Boylston Street Floor 2, Suite 202, Newton, MA 02459-2863 | 2019-08-01 |
| 1346701075 | Passport Health Holdings, LLC | Preventive Medicine | 563 W 500 South, Suite 215, Bountiful, UT 84010-8172 | 2019-03-26 |
| 1972085587 | Passport Health Holdings, LLC | Clinic/Center | 3375 E. Capital Circle Ne Bldg E, Suite 3, Tallahassee, FL 32308-3778 | 2018-08-30 |
| 1619488103 | Passport Health Holdings, LLC | Community Health Worker | 14985 W Bell Rd Bldg 12-a, Surprise, AZ 85374-3231 | 2017-10-24 |
| 1528593761 | Passport Health Holdings, LLC | Preventive Medicine | 18 Tremont Street, Suite 404, Boston, MA 02108-2304 | 2017-04-25 |
| 1578004008 | Passport Health Holdings, LLC | Preventive Medicine | 1116 E Route 66, Flagstaff, AZ 86001-4706 | 2017-03-16 |
| 1558802082 | Passport Health Holdings, LLC | Preventive Medicine | 2601 N. 3rd Street, Ste 102, Phoenix, AZ 85004-1145 | 2017-03-16 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Massachusetts Corporations | PASSPORT HEALTH HOLDINGS, LLC | 8324 E. Hartford Dr. Ste. 200, Scottsdale, AZ 85255 |
| Street Address |
111 WILLIARD STREET SUITE GC |
| City | QUINCY |
| State | MA |
| Zip Code | 02169-1200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902427933 | Trinasia Jones | Counselor | 80 Quarry Street, 3, Quincy, MA 02169 | 2020-04-30 |
| 1164060778 | Bid-milton Physician Associates Inc | Clinic/Center | 100 Walter J. Hannon Pkwy, Quincy, MA 02169 | 2019-12-13 |
| 1669028064 | Renee Yvette Belisle | Occupational Therapist | 1266 Furnance Brook Parkway, Suite #100b, Quincy, MA 02169 | 2019-08-13 |
| 1952953713 | Phuc Thi Diem Ho | Registered Nurse | 18 Rustic Place, Quincy, MA 02169 | 2019-07-11 |
| 1518451939 | Lucille Jordan | Social Worker | 1175 Sea St, Quincy, MA 02169 | 2018-06-19 |
| 1326567447 | Tara Barney | Counselor | 290 Quarry Street Apt. 112, Quincy, MA 02169 | 2017-09-11 |
| 1295251007 | Iona Dental, P.C. (parent Organization) | Dentist | 10 Granite Street, Unit - 4c, Quincy, MA 02169 | 2017-08-15 |
| 1730610247 | Amy S. Chung | Family Medicine | 100 Walter J. Hannon Parkway, Quincy, MA 02169 | 2017-03-26 |
| 1205377314 | Wing Man Ting | Counselor | 2 Moon Island Road, Quincy, MA 02169 | 2017-03-09 |
| 1740726223 | Cameron James Dumas | Pharmacist | 21 23 Stanhope Street, Boston, MA 02169 | 2017-01-09 |
| Find all providers in zip 02169 | ||||
| Taxonomy Code | 2083P0901X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Public Health & General Preventive Medicine |
| Public health and general preventive medicine focuses on promoting health, preventing disease, and managing the health of communities and defined populations. These practitioners combine population-based public health skills with knowledge of primary, secondary, and tertiary prevention-oriented clinical practice in a wide variety of settings. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Preventive Medicine, 2007. http://www.abprevmed.org/. American Osteopathic Board of Preventive Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134374150 | Landis Crockett | Preventive Medicine | 2964 Lakeview Point Rd, Quincy, FL 32351-0493 | 2008-11-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831705904 | New Moon Acupuncture Pllc | Preventive Medicine | 557 Mount Auburn St Ste 2, Watertown, MA 02472-4102 | 2020-09-23 |
| 1528593761 | Passport Health Holdings, LLC | Preventive Medicine | 18 Tremont Street, Suite 404, Boston, MA 02108-2304 | 2017-04-25 |
| 1720510977 | Zen Den Medical Inc. | Preventive Medicine | 392 Washington St, Norwell, MA 02061-2008 | 2017-03-28 |
| 1992121024 | Passport Health Holdings, LLC | Preventive Medicine | 500 West Cummings Park, Suite 2475, Woburn, MA 01801-5536 | 2014-03-13 |
| 1720217441 | Anthony F Milano | Preventive Medicine | 110 Keveney Lane, Cummaquid, MA 02637 | 2009-07-02 |
| 1508037169 | Aneel Advani | Preventive Medicine | 57 Wall St, Wellesley, MA 02481-4819 | 2008-03-21 |
| 1609095751 | Lewis Mantel | Preventive Medicine | Board of Health, 16 Gr. Neck Rd. North, Mashpee, MA 02649 | 2007-04-25 |
| 1942429261 | Eleanor G Shore | Preventive Medicine | 62 Meadowbrook Rd, Needham, MA 02492-1914 | 2007-04-25 |
| 1780808246 | Stan N Finkelstein | Preventive Medicine | 117 Lexington Rd, Lincoln, MA 01773-2206 | 2007-04-13 |
| 1134343692 | Marise S Gottlieb | Preventive Medicine | 215 Chestnut Hill Rd, Chestnut Hill, MA 02467-1313 | 2007-04-13 |
| 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.