SIGNATURE HEALTHCARE MEDICAL GROUP, INC. (NPI# 1508804949) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508804949 |
| Entity Type | Organization |
| Organization Name | SIGNATURE HEALTHCARE MEDICAL GROUP, INC. |
| Other Organization Name | SIGNATURE MEDICAL GROUP |
| Practice Address |
680 Centre St Brockton MA 02302-3308 |
| Practice Telephone | 5089417000 |
| Mailing Telephone | 5088940400 |
| Mailing Fax Number | 5089410893 |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2020-07-20 |
| Authorized Official Name | MR. KIM HOLLON (CEO) |
| Authorized Official Telephone | 5089417004 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians | ||
| N | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians | ||
| N | 104100000X | Social Worker | Behavioral Health & Social Service Providers | ||
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
Allopathic & Osteopathic Physicians | ||
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208800000X | Urology | Allopathic & Osteopathic Physicians | ||
| N | 208M00000X | Hospitalist | Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | 240642 | MA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 110072349A | 05 | |
| MA | BCBS GROUP # | M16402 | 01 |
| Other Name | Type Code |
|---|---|
| Signature Medical Group | Doing Business As Name - Organization |
| 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 |
| Find all providers in the same location | ||||
| 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 | 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 |
|---|---|---|---|---|
| 1710349329 | Jill Elizabeth Harrington | Internal Medicine | Va Boston; Brockton Campus, 940 Belmont Street, Brockton, MA 02301 | 2016-03-23 |
| 1487800900 | Tinah L Canda | Internal Medicine | 1300 Belmont St, Brockton, MA 02301-4433 | 2008-08-15 |
| 1689836868 | Alireza H Nezhad | Internal Medicine | 25 Libby St, Brockton, MA 02302-2949 | 2008-06-27 |
| 1437360302 | Francis H. Freccero, M.d. | Internal Medicine | 77 Byron Ave, Brockton, MA 02301-4201 | 2007-05-24 |
| 1679665442 | Edward Francis Freccero | Internal Medicine | 77 Bryon Avenue, Brockton, MA 02301-4201 | 2006-09-29 |
| 1104927102 | Bahige Asaker | Internal Medicine | 1020 Pleasant Street, Brockton, MA 02301-5055 | 2006-09-25 |
| 1568578425 | Chandrika Kambam | Internal Medicine | Bridgewater Goddard Medical Park Assoc., 110 Liberty Street, Brockton, MA 02301 | 2006-08-22 |
| 1689607079 | Robert G Covett | Internal Medicine | 178 Quincy Ave, Brockton, MA 02302-2803 | 2006-07-08 |
| 1689613911 | Roland J. Florio | Internal Medicine | 1300 Belmont Street, Brockton, MA 02301-4433 | 2006-06-05 |
| 1295772309 | Felix U Mayers | Internal Medicine | 130 Quincy Ave, Brocton Hospital, Brockton, MA 02302-2803 | 2006-05-31 |
| Find all providers in BROCKTON | ||||
Please comment or provide details below to improve the information on SIGNATURE HEALTHCARE MEDICAL GROUP, INC..
| 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.