ERICKSON HEALTH MEDICAL GROUP OF MASSACHUSETTS PC (NPI# 1164442919) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164442919 |
| Entity Type | Organization |
| Organization Name | ERICKSON HEALTH MEDICAL GROUP OF MASSACHUSETTS PC |
| Other Organization Name | BROOKSBY MEDICAL CENTER |
| Practice Address |
100 Brooksby Village Dr Peabody MA 01960-1438 |
| Mailing Address |
5525 Research Park Dr 4th Floor Baltimore MD 21228-4664 |
| Practice Telephone | 9785367850 |
| Practice Fax Number | 9785367051 |
| Mailing Telephone | 9785367850 |
| Mailing Fax Number | 8772809727 |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2015-04-21 |
| Authorized Official Name | DR. MATTHEW J NARRETT (SENIOR VP AND CHIEF MEDICAL OFFICER) |
| Authorized Official Telephone | 4104022257 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 213E00000X | Podiatrist | Podiatric Medicine & Surgery Service Providers | ||
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 364SP0808X |
Clinical Nurse Specialist Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 364SG0600X |
Clinical Nurse Specialist Specialization: Gerontology |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BCBS | M17596 | 01 | |
| MA | 9731610 | 05 | |
| BCBS OF MA | 1427124015 | 01 |
| Other Name | Type Code |
|---|---|
| Brooksby Medical Center | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740436187 | Erickson Health Medical Group of Massachusetts PC | Durable Medical Equipment & Medical Supplies | 300 Linden Ponds Way, Hingham, MA 02043-3769 | 2008-08-18 |
| 1295755056 | Erickson Health Medical Group of Massachusetts PC | Family Medicine | 300 Linden Ponds Way, Hingham, MA 02043-3769 | 2006-07-21 |
| Street Address |
100 BROOKSBY VILLAGE DR |
| City | PEABODY |
| State | MA |
| Zip Code | 01960-1438 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962407536 | Randolph S. Powers | Family Medicine | 100 Brooksby Village Dr, Peabody, MA 01960-1438 | 2005-06-20 |
| 1881104032 | Caroline Margaret Sims | Social Worker | 100 Brooksby Village Dr, Peabody, MA 01960-1438 | 2017-10-02 |
| 1639447006 | Erickson Health Medical Group of Massachusetts, P.c . | Assisted Living Facility | 100 Brooksby Village Dr, Peabody, MA 01960-1438 | 2011-12-13 |
| 1215229620 | Sarah Robertson | Nurse Practitioner | 100 Brooksby Village Dr, Peabody, MA 01960-1438 | 2011-05-04 |
| 1265688352 | Erickson Health Medical Group of Ma | Durable Medical Equipment & Medical Supplies | 100 Brooksby Village Dr, Peabody, MA 01960-1438 | 2008-08-08 |
| 1669656187 | Donna M Agave | Nurse Practitioner | 100 Brooksby Village Dr, Peabody, MA 01960-1438 | 2007-12-19 |
| 1992852099 | Dennis A Tuck | Podiatrist | 100 Brooksby Village Dr, Peabody, MA 01960-1438 | 2007-01-04 |
| 1326115106 | Main Street Pharmacy, LLC | Pharmacy | 100 Brooksby Village Dr, Peabody, MA 01960-1438 | 2006-11-29 |
| 1154337681 | Ajaykumar S Patel | Internal Medicine | 100 Brooksby Village Dr, Peabody, MA 01960-1438 | 2006-08-01 |
| 1326077124 | Janis Carmody | Nurse Practitioner | 100 Brooksby Village Dr, Peabody, MA 01960-1438 | 2006-07-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962020321 | Kathleen Marie Cliffe | Nurse Practitioner | 15 Sandra Rd, Peabody, MA 01960 | 2020-07-10 |
| 1801398102 | Janis Melanson | Counselor | Higgins Middle School, 85 Perkins Street, Peabody, MA 01960 | 2018-03-02 |
| 1679082036 | Kelsey Ann Lima | Social Worker | 9 Centennial Drive, Suite 202, Peabody, MA 01960 | 2017-09-28 |
| 1609394485 | Victoria Jade Olechowski | Specialist/Technologist | 1002 Crane Brook Way, Peabody, MA 01960 | 2017-08-31 |
| 1841715711 | Alexandra Lee Chasse | Counselor | 9 Cenntenial Drive, Suit 202, Peabody, MA 01960 | 2017-08-11 |
| 1275982936 | Miguel A Roque | Dentist | 6 Essex Center Drive Suite 110, Peabody, MA 01960 | 2016-06-03 |
| 1528412061 | Kabamedicalcorporation | Durable Medical Equipment & Medical Supplies | 484lowell Street, Peabody, MA 01960 | 2016-04-21 |
| 1437510815 | Ana Tereza T. Wescott | Dentist | 89 Foster Street, Peabody Family Health Center, Peabody, MA 01960 | 2016-03-14 |
| 1225496474 | Ashley Motta | Counselor | 24 Jennifer Lane, Peabody, MA 01960 | 2016-02-03 |
| 1578942645 | Cerebral Palsy of Eastern Mass Incorporated | Early Intervention Provider Agency | 6 Stratis Way, Peabody, MA 01960 | 2015-05-22 |
| Find all providers in zip 01960 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285145441 | Congenial Healthcare, LLC | Internal Medicine | 2 1st Ave Ste 215, Peabody, MA 01960-4962 | 2017-10-16 |
| 1730608720 | Congenial Healthcare, LLC | Internal Medicine | 1 Roosevelt Ave Ste 201, Peabody, MA 01960-2227 | 2017-09-12 |
| 1841637535 | Neetu Mulchandani | Internal Medicine | Laehy Hospital and Medical Center, 1 Essex Center Drive, Peabody, MA 01960-2901 | 2013-06-04 |
| 1861705923 | The Care Physicain's LLC | Internal Medicine | 15 King St, Peabody, MA 01960-4379 | 2010-07-19 |
| 1609067917 | Linus Sungsik Hahn | Internal Medicine | 6 Essex Center Dr Ste 304, Peabody, MA 01960-2907 | 2007-08-05 |
| 1548347750 | Claudia M Racalbuto | Internal Medicine | One Roosevelt Avenue Suite 204, Peabody, MA 01960 | 2006-11-01 |
| 1184634834 | Susan C. Elias | Internal Medicine | 1 Essex Center Dr., Lahey Northshore, Peabody, MA 01960-2901 | 2006-08-08 |
| 1598711285 | Jing Yu | Internal Medicine | 6 Essex Center Dr Ste 201, Peabody, MA 01960-2906 | 2006-05-25 |
| 1720045719 | Elise Rodman | Internal Medicine | 2 Essex Center Drive, Peabody, MA 01960 | 2006-04-26 |
| 1174505507 | David G Mulder | Internal Medicine | 100 Brooksby Village Drive, Brooksby Medical Clinic, Peabody, MA 01960 | 2005-11-21 |
| Find all providers in PEABODY | ||||
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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.