EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC (NPI# 1609842152) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609842152 |
| Entity Type | Organization |
| Organization Name | EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC |
| Other Organization Name | GREAT BROOK VALLEY HEALTH CENTER, INC |
| Practice Address |
19 Tacoma St Worcester MA 01605-3516 |
| Mailing Address |
650 Lincoln St Worcester MA 01605-2060 |
| Practice Telephone | 5088521805 |
| Practice Fax Number | 5088543248 |
| Mailing Telephone | 5088542122 |
| Mailing Fax Number | 5088538593 |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2019-11-27 |
| Authorized Official Name | MR. STEPHEN J. KERRIGAN (PRESIDENT & CEO) |
| Authorized Official Telephone | 5088542122 |
| Is Organization Subpart | Y |
| Parent Organization Name | EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
4039 | MA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 1301071 | 05 | |
| MA | 1320858 | 05 | |
| MA | 0443891 | 05 | |
| MA | 110022061B | 05 | |
| MA | BCBS OF MA | Y10100 | 01 |
| Other Name | Type Code |
|---|---|
| Great Brook Valley Health Center, Inc | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568828622 | Edward M. Kennedy Community Health Center, Inc | Registered Nurse | 354 Waverly St, Framingham, MA 01702-7079 | 2016-01-05 |
| 1316324650 | Edward M. Kennedy Community Health Center, Inc | Clinic/Center | 631 Lincoln St, Worcester, MA 01605-2010 | 2015-05-06 |
| 1992137426 | Edward M. Kennedy Community Health Center, Inc | Clinic/Center | 42 Cape Rd, Milford, MA 01757-3292 | 2013-08-07 |
| 1700152758 | Edward M. Kennedy Community Health Center, Inc | Clinic/Center | 585 Lincoln St, Worcester, MA 01605-1906 | 2012-03-23 |
| 1154600344 | Edward M. Kennedy Community Health Center, Inc | Clinic/Center | 354 Waverly St, Framingham, MA 01702-7079 | 2011-08-05 |
| 1497984363 | Edward M. Kennedy Community Health Center, Inc | Clinic/Center | 72 Union Ave, Framingham, MA 01702-8216 | 2009-07-13 |
| 1013048347 | Edward M. Kennedy Community Health Center, Inc | Pharmacy | 19 Tacoma St, Worcester, MA 01605-3516 | 2007-03-08 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC. | 650 Lincoln St Ste 1, Worcester, MA 01605-2060 |
| Street Address |
19 TACOMA ST |
| City | WORCESTER |
| State | MA |
| Zip Code | 01605-3516 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114902038 | Gina E. D'ottavio | Family Medicine | 19 Tacoma St, Worcester, MA 01605-3516 | 2005-12-14 |
| 1952909319 | Michelle Elicier | Licensed Practical Nurse | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-10-16 |
| 1396342275 | Christine Anne Tuohy | Registered Nurse | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-10-05 |
| 1437756335 | Madeline Fennon Lane | Registered Nurse | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-10-04 |
| 1962016584 | Julie Fraher | Registered Nurse | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-09-01 |
| 1598377699 | Victor O Boadu | Registered Nurse | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-08-19 |
| 1053922963 | Shanoska Vasquez Garcia | Counselor | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-08-13 |
| 1588289300 | Jeffrey P Chhim | Registered Nurse | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-06-09 |
| 1629692470 | Diana Portillo | Registered Nurse | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-06-07 |
| 1467076810 | Stacie Robbins | Pharmacist | 19 Tacoma St, Worcester, MA 01605-3516 | 2020-06-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083228340 | Francisca A Bediako | Registered Nurse | Commonwealth Care Alliance, 100 North Parkway-suite # 202, Worcester, MA 01605 | 2020-09-03 |
| 1922660646 | Jenna Patricia Mullarkey | Counselor | Ummmc, Hahnemann Family Health Center, 279 Lincoln Street, Worcester, MA 01605 | 2019-07-02 |
| 1295219293 | Valerie Ann Wedge | Social Worker | 382 Plantation Street, Worcester, MA 01605 | 2018-09-17 |
| 1154800290 | Keri Innis-grant | Counselor | 108 Grove Street, Ste Ll11, Worcester, MA 01605 | 2018-08-09 |
| 1184119463 | Madiinah Namutebi | Registered Nurse | 56 Olga Ave, Worcester, MA 01605 | 2018-06-28 |
| 1841789310 | Ashley Murray | Psychologist | 361 Plantation St., Attn: Forensic Services, Worcester, MA 01605 | 2018-05-09 |
| 1184126419 | Nadia Saforo | Nurse Practitioner | 509 Plantation St Apt 221, Worcester, MA 01605 | 2018-03-02 |
| 1548779044 | Arnold Kamau Thuku | Behavioral Analyst | 55 Erie Ave, Worcester, MA 01605 | 2017-09-27 |
| 1417466483 | Sabine Erica Charles-arbouet | Registered Nurse | 25 Oriol Drive, Worcester, MA 01605 | 2017-09-21 |
| 1548787864 | Alyssa Lynn Champagne | Behavioral Analyst | 19 Judson Rd, Worcester, MA 01605 | 2017-08-28 |
| Find all providers in zip 01605 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780183913 | Family Health Center of Worcester, Inc. | Clinic/Center | 420 Grafton St, Worcester, MA 01604-3802 | 2018-02-02 |
| 1225323777 | Family Health Center of Worcester, Inc. | Clinic/Center | 14 Richards St, Goddard Health Center, Worcester, MA 01603-2609 | 2011-06-13 |
| 1801181334 | Family Health Center of Worcester, Inc. | Clinic/Center | 140 Apricot St, Sullivan Middle Health Center, Worcester, MA 01603-1225 | 2011-06-13 |
| 1720373251 | Family Health Center of Worcester, Inc. | Clinic/Center | 299 Highland St, Doherty School Based Health Center, Worcester, MA 01602-2110 | 2011-06-13 |
| 1144514316 | Family Health Center of Worcester, Inc. | Clinic/Center | 15 Claremont St, School-based Health Center, Worcester, MA 01610-1436 | 2011-06-06 |
| 1558530246 | Family Health Center of Worcester, Inc | Clinic/Center | 23 N Ashland St, Worcester, MA 01609-3041 | 2008-02-27 |
| 1720647209 | Family Health Center of Worcester, Inc. | Clinic/Center | 162 Chandler St, Worcester, MA 01609-2924 | 2019-06-10 |
| 1316324650 | Edward M. Kennedy Community Health Center, Inc | Clinic/Center | 631 Lincoln St, Worcester, MA 01605-2010 | 2015-05-06 |
| 1700152758 | Edward M. Kennedy Community Health Center, Inc | Clinic/Center | 585 Lincoln St, Worcester, MA 01605-1906 | 2012-03-23 |
| 1770878225 | Family Health Center of Worcester, Inc. | Clinic/Center | 170 Apricot St, School-based Health Center, Worcester, MA 01603-1225 | 2011-06-13 |
| Find all providers in WORCESTER | ||||
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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.