BROCKTON HOSPITAL, INC. (NPI# 1497776215) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497776215 |
| Entity Type | Organization |
| Organization Name | BROCKTON HOSPITAL, INC. |
| Other Organization Name | SIGNATURE HEALTHCARE BROCKTON HOSPITAL |
| Practice Address |
680 Centre St Brockton MA 02302-3308 |
| Mailing Address |
Po Box 844056 Boston MA 02284-4056 |
| Practice Telephone | 5089417000 |
| Mailing Telephone | (508) 941-7555 |
| Mailing Fax Number | 5089416303 |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2017-09-07 |
| Authorized Official Name | MR. KIM HOLLON (CEO) |
| Authorized Official Telephone | 5089417004 |
| Is Organization Subpart | Y |
| Parent Organization Name | BROCKTON HOSPITAL, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 273Y00000X | Rehabilitation Unit | Z07 | MA | Hospital Units |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 110026502A | 05 |
| Other Name | Type Code |
|---|---|
| Signature Healthcare Brockton Hospital | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770504599 | Brockton Hospital, Inc. | General Acute Care Hospital | 680 Centre St, Brockton, MA 02302-3308 | 2006-07-21 |
| 1689695405 | Brockton Hospital, Inc. | Psychiatric Unit | 680 Centre St, Brockton, MA 02302-3308 | 2006-07-21 |
| 1063431286 | Brockton Hospital, Inc. | General Acute Care Hospital | 680 Centre St, Brockton, MA 02302-3308 | 2006-07-19 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | BROCKTON HOSPITAL, INC. | 680 Centre St, Brockton, MA 02302-3308 |
| Street Address |
680 CENTRE ST |
| City | BROCKTON |
| State | MA |
| Zip Code | 02302-3308 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639176910 | Marcia Waitzman | Obstetrics & Gynecology | 680 Centre St, Brockton, MA 02302-3308 | 2005-07-01 |
| 1770196396 | Samantha Lipsky | Physician Assistant | 680 Centre St, Brockton, MA 02302-3308 | 2020-08-24 |
| 1760009328 | Mandi Ella Clegg | Social Worker | 680 Centre St, Brockton, MA 02302-3308 | 2020-06-30 |
| 1972128643 | Matthew Hall Wilson | Student in an Organized Health Care Education/Training Program | 680 Centre St, Brockton, MA 02302-3308 | 2020-06-09 |
| 1679198493 | Alyssa Dicosmo | Student in an Organized Health Care Education/Training Program | 680 Centre St, Brockton, MA 02302-3308 | 2020-06-09 |
| 1720603566 | Tessie Allan | Student in an Organized Health Care Education/Training Program | 680 Centre St, Brockton, MA 02302-3308 | 2020-06-08 |
| 1588289375 | Collin Rozanski | Student in an Organized Health Care Education/Training Program | 680 Centre St, Brockton, MA 02302-3308 | 2020-06-08 |
| 1619592417 | Balaji Arun Jothishankar | Student in an Organized Health Care Education/Training Program | 680 Centre St, Brockton, MA 02302-3308 | 2020-06-08 |
| 1013532845 | Angell Shi | Student in an Organized Health Care Education/Training Program | 680 Centre St, Brockton, MA 02302-3308 | 2020-06-08 |
| 1386269124 | Rebecca Yanovsky | Student in an Organized Health Care Education/Training Program | 680 Centre St, Brockton, MA 02302-3308 | 2020-06-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427513373 | Miriam Monteiro | Social Worker | 688 Plain Street, Brockton, MA 02302 | 2019-02-05 |
| 1619432523 | Shirley Elefson | Social Worker | 330 Crescent Street, Brockton, MA 02302 | 2019-02-05 |
| 1578055505 | Steigmward Desir | Specialist | 472 E Ashland St, Brockton, MA 02302 | 2018-06-05 |
| 1114417797 | Katherine Douglas Van Schaik | Student in an Organized Health Care Education/Training Program | Brockton Signature Healthcare-bidmc, 680 Centre Street, Brockton, MA 02302 | 2018-05-18 |
| 1700376365 | Emmanuel Carrodeguas | Student in an Organized Health Care Education/Training Program | Brockton Hospital, 680 Centre Street, Brockton, MA 02302 | 2018-05-18 |
| 1700303856 | My Care, LLC | Home Health | 307 Field Street, Brockton, MA 02302 | 2017-08-29 |
| 1982124988 | Shavon Franks | Psychologist | 30 Downey Rd, Brockton, MA 02302 | 2017-06-21 |
| 1831629286 | Kings & Queens Empowered | Religious Nonmedical Health Care Institution | 312 Carl Ave, Brockton, MA 02302 | 2017-06-18 |
| 1487193389 | Roseline Eliezer | Licensed Practical Nurse | 17 Simeon Avenue, Brockton, MA 02302 | 2017-02-13 |
| 1184008989 | Danielle Parker | Student in an Organized Health Care Education/Training Program | 23 Grinnell Rd, Brockton, MA 02302 | 2015-07-13 |
| Find all providers in zip 02302 | ||||
| Taxonomy Code | 273Y00000X |
| Grouping | Hospital Units |
| Classification | Rehabilitation Unit |
| In general, a distinct unit of a general acute care hospital that provides care encompassing a comprehensive array of restoration services for the disabled and all support services necessary to help patients attain their maximum functional capacity. Source: AHA Annual Survey p. A10 1996 AHA Guide. For Medicare, a distinct part of a general acute care hospital providing inpatient rehabilitation services that meets the following requirements. Rehabilitation Units have in effect a preadmission screening procedure under which each prospective patient’s condition and medical history are reviewed to determine whether the patient is likely to benefit significantly from an intensive inpatient program or assessment; ensure that the patients receive close medical supervision and furnish, through the use of qualified personnel, rehabilitation nursing, physical therapy and occupational therapy, plus, as needed, speech therapy, social services or psychological services and orthotic and prosthetic services; have a plan of treatment for each inpatient that is established, reviewed, and revised as needed by a physician in consultation with other professional personnel who provide services to the patient; use a coordinated multidisciplinary team approach in the rehabilitation of each inpatient, as documented by periodic clinical entries made in the patient’s medical record to note the patient's status in relationship to goal attainment, and that team conferences are held at least every two weeks to determine the appropriateness of treatment; have a director of rehabilitation who provides services to the unit and its inpatients for at least 20 hours a week, is a doctor of medicine or osteopathy, is licensed under State law to practice medicine or surgery, and has had, after completing a one-year hospital internship at least two years of training or experience in the medical management of inpatients requiring rehabilitation services. |
| Notes: Source: Code of Federal Regulations #42, Section 412.29. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508263369 | Boston Va Healthcare System | Rehabilitation Unit | 940 Belmont St, Boston Healthcare System, Brockton, MA 02301 | 2014-11-21 |
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| 1942697230 | Christie Rose Carusotto | Rehabilitation Unit | 1730 Swamp Rd, Richmond, MA 01254-5162 | 2015-04-24 |
| 1790045797 | Cambridge Health Alliance | Rehabilitation Unit | 2 Middlesex Avenue, Somerville, MA 02145 | 2012-05-23 |
| 1154625028 | Medminder Systems, Inc. | Rehabilitation Unit | 20 Tanglewood Rd, Newton, MA 02459-2862 | 2011-01-06 |
| 1053709089 | North Shore Speech Therapy | Rehabilitation Unit | 1r Newbury St, Ste 303, Peabody, MA 01960-3864 | 2014-12-29 |
| 1518219120 | Massachusetts General Hospital | Rehabilitation Unit | 15 Parkman Street, Wang Ambulatory Care Center, Boston, MA 02114 | 2012-10-05 |
| 1760783575 | Metro West Rehab Corp | Rehabilitation Unit | 150 Flanders Rd, Westborough, MA 01581-1017 | 2010-11-10 |
| 1679874481 | Brn Corporation | Rehabilitation Unit | 145 Ward Hill Ave, Bradford, MA 01835-6928 | 2010-11-10 |
| 1750402988 | Cambridge Public Health Commission | Rehabilitation Unit | 1493 Cambridge St, Whidden Tcu Npi, Cambridge, MA 02139-1047 | 2007-04-03 |
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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.