BAYSTATE MEDICAL CENTER, INC. (NPI# 1629409875) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629409875 |
| Entity Type | Organization |
| Organization Name | BAYSTATE MEDICAL CENTER, INC. |
| Other Organization Name | BAYSTATE PHARMACY |
| Practice Address |
50 Wason Ave Springfield MA 01107-1132 |
| Mailing Address |
50 Wason Ave Springfield MA 01107-1274 |
| Practice Telephone | 4137949009 |
| Practice Fax Number | 4137949013 |
| Mailing Telephone | 4137949009 |
| Mailing Fax Number | 4137949013 |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2017-04-12 |
| Authorized Official Name | GARY KERR (CHIEF PHARMACY OFFICER) |
| Authorized Official Telephone | 4137943178 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
DS89896 | MA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | CONTROLLED SUBSTANCE REGISTRATION | CS89896 | 01 |
| MA | MA DRUG STORE NUMBER | DS89896 | 01 |
| DEA NUMBER | FB4278304 | 01 |
| Other Name | Type Code |
|---|---|
| BAYSTATE PHARMACY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972936623 | Baystate Medical Center, Inc. | Pharmacy | 3300 Main St, Springfield, MA 01107-1112 | 2013-08-16 |
| 1922301779 | Baystate Medical Center, Inc. | Durable Medical Equipment & Medical Supplies | 85 South St, Room D101, Ware, MA 01082-1625 | 2010-12-17 |
| 1881799427 | Baystate Medical Center, Inc. | Pharmacy | 140 High St, Springfield, MA 01105-1442 | 2006-09-14 |
| 1861597411 | Baystate Medical Center, Inc. | Pharmacy | 380 Plainfield St, Springfield, MA 01107-1524 | 2006-09-14 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | BAYSTATE MEDICAL CENTER, INC. | 759 Chestnut St, Springfield, MA 01199-1001 |
| Connecticut Business Registrations | BAYSTATE MEDICAL CENTER, INC. | 759 Chestnut Street, Springfield, MA 01199 |
| Street Address |
50 WASON AVE |
| City | SPRINGFIELD |
| State | MA |
| Zip Code | 01107-1132 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265413009 | Anastasios G Angelides | Pediatrics | 50 Wason Ave, 1st Fl, Springfield, MA 01107-1274 | 2005-11-09 |
| 1932727203 | Georgianna Rose Shea | Nurse Practitioner | 50 Wason Ave, 1st Fl, Springfield, MA 01107-1274 | 2020-07-13 |
| 1588118350 | Courtney Manning | Genetic Counselor, MS | 50 Wason Ave, Springfield, MA 01107-1274 | 2016-08-10 |
| 1457708455 | Samantha Mccarthy | Dietitian, Registered | 50 Wason Ave, Springfield, MA 01107-1274 | 2016-05-19 |
| 1881057800 | Baystate Developmental Behavioral Pediatrics | Psychologist | 50 Wason Ave, 1st. Floor, Springfield, MA 01107-1274 | 2016-03-29 |
| 1912370438 | Brenda Peters | Behavioral Analyst | 50 Wason Ave, Springfield, MA 01107-1132 | 2015-11-05 |
| 1053795351 | Shayl Griffith | Student in an Organized Health Care Education/Training Program | 50 Wason Ave, Springfield, MA 01107-1132 | 2015-07-16 |
| 1043620859 | Lisa Laprade | Dietitian, Registered | 50 Wason Ave, 1st Floor, Springfield, MA 01107-1132 | 2014-05-01 |
| 1245650225 | Baystate Pharmacy | Pharmacy | 50 Wason Ave, Springfield, MA 01107-1132 | 2014-04-17 |
| 1669898565 | Ruth Kurniawati | Physician Assistant | 50 Wason Ave, Springfield, MA 01107-1132 | 2014-03-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740702547 | Domingo Nieves Jr. | Counselor | 2225 Main St., Springfield, MA 01107 | 2017-07-13 |
| 1801318266 | Denise Lawson | Counselor | 2257 Main Street, Springfield, MA 01107 | 2017-07-07 |
| 1568912491 | Trina Cysz | Nurse Practitioner | 101 Wason Avenue, Commonwealth Care Alliance, Springfield, MA 01107 | 2016-10-04 |
| 1609322262 | Toheeb Oladimeji Bakare | Counselor | 322 Birnie Avenue, Springfield, MA 01107 | 2016-09-01 |
| 1952701161 | Jalissa Sostre | Counselor | 32 Abbe Ave, Springfield, MA 01107 | 2014-08-26 |
| 1659799161 | Elizabeth A. Otmaskin | Obstetrics & Gynecology | 3455 Main Street Suite C, Baysttate Ob Gyn Group Inc, Springfield, MA 01107 | 2014-04-01 |
| 1205268885 | Catherine Matejcek Davies | Counselor | 246 Park Street, Springfield, MA 01107 | 2013-08-06 |
| 1750723268 | Jasdeep S. Badwal | Allergy & Immunology | 2 Medical Center Dr Ste 406, Springfield, MA 01107 | 2013-07-25 |
| 1255691846 | Medical Express Urgent Care Center, Co. Inc. | Physical Medicine & Rehabilitation | 438 Chestnut Street, Springfield, MA 01107 | 2012-05-17 |
| 1205166642 | Matthew R Kelley | Audiologist | 100 Wason, Suite 100, Springfield, MA 01107 | 2010-01-07 |
| Find all providers in zip 01107 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1770093122 | Genoa Healthcare, LLC | Pharmacy | 417 Liberty St Ste 1b, Springfield, MA 01104-3739 | 2017-10-11 |
| 1316483266 | Springfield Clinic, LLP | Pharmacy | 900 N 1st St Rm 4066, Springfield, IL 62702-3749 | 2017-01-17 |
| 1194277681 | Grove Professional Pharmacy, Inc | Pharmacy | 1636 S Glenstone Ave Ste 108, Springfield, MO 65804-1512 | 2016-10-31 |
| 1962852012 | Main Sail Enterprises South LLC | Pharmacy | 222 E Primrose St Ste B, Springfield, MO 65807-5233 | 2016-06-20 |
| 1588042816 | Main Sail Enterprises-downtown LLC | Pharmacy | 655 S Campbell Ave, Springfield, MO 65806-2901 | 2015-05-06 |
| 1972901189 | Fred's Stores of Tennessee Inc | Pharmacy | 1117 Lincoln Park Rd, Springfield, KY 40069 | 2014-12-22 |
| 1417363516 | Springfield Family Pharmacy, Inc | Pharmacy | 175 Carew St, Suite 100, Springfield, MA 01104 | 2014-07-09 |
| 1932529716 | Walgreen Co | Pharmacy | 440 E Tampa St Ste 100, Springfield, MO 65806-1131 | 2014-04-21 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 01107 |
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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.