PREVENTIVE MEDICINE ASSOCIATES (NPI# 1659679793) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659679793 |
| Entity Type | Organization |
| Organization Name | PREVENTIVE MEDICINE ASSOCIATES |
| Other Organization Name | ROXBURY WELLNESS CENTER |
| Practice Address |
2201 Washington St Suite 302 Roxbury MA 02119-3212 |
| Practice Telephone | 6175418090 |
| Practice Fax Number | 6175418094 |
| Mailing Telephone | 6175418090 |
| Mailing Fax Number | 6175418094 |
| Enumeration Date | 2011-03-13 |
| Last Update Date | 2011-03-13 |
| Authorized Official Name | MS. MARY J DELONG (CREDENTIALING MANAGER) |
| Authorized Official Telephone | 4132227711 |
| Authorized Official Credential | MM, RHIA |
| Is Organization Subpart | Y |
| Parent Organization Name | PREVENTIVE MEDICINE ASSOCIATES |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Roxbury Wellness Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528353612 | Preventive Medicine Associates | Family Medicine | 154 Lynnway, Suite 1c, Lynn, MA 01902-3479 | 2011-06-16 |
| 1568760601 | Preventive Medicine Associates | Family Medicine | 501b Washington St, Dorchester Center, MA 02124-2014 | 2011-03-13 |
| 1962705251 | Preventive Medicine Associates | Family Medicine | 9 Henshaw St, Brighton, MA 02135-2905 | 2010-12-08 |
| 1326350976 | Preventive Medicine Associates | Family Medicine | 360 Coggeshall St, New Bedford, MA 02746-1923 | 2010-07-12 |
| 1689900565 | Preventive Medicine Associates | Family Medicine | 322 Gifford St, Falmouth, MA 02540 | 2009-10-27 |
| 1962641159 | Preventive Medicine Associates | Family Medicine | 63 Winthrop St, # C1, C2, Taunton, MA 02780-6218 | 2009-02-11 |
| 1578702957 | Preventive Medicine Associates | Counselor | 3261 Main St, Barnstable, MA 02630-1105 | 2009-02-09 |
| 1356507511 | Preventive Medicine Associates | Family Medicine | 98 Suffolk St, Holyoke, MA 01040-4458 | 2008-08-06 |
| 1588093744 | Preventive Medicine Associates | Specialist | 1919 Sw 10th Ave, Suite 22, Topeka, KS 66604-1425 | 2013-11-07 |
| 1427360072 | Preventive Medicine Associates | Family Medicine | 451 Andover St, Suite 195, North Andover, MA 01845-5044 | 2010-07-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Massachusetts Corporations | PREVENTIVE MEDICINE ASSOCIATES, INC. | 59 Temple Place, Suite 612, Boston, MA 02111 |
| Street Address |
2201 WASHINGTON ST SUITE 302 |
| City | ROXBURY |
| State | MA |
| Zip Code | 02119-3212 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427661644 | Christina Kim Hunt | Case Manager/Care Coordinator | 75 Amory St, Garden Level, Boston, MA 02119 | 2020-08-27 |
| 1962021089 | Taha Fathima Khan | Student in an Organized Health Care Education/Training Program | Boston Medical Center, 801 Albany Street, 3rd Floor, Department of Pediatrics, Boston, MA 02119 | 2020-04-09 |
| 1154957132 | Katherine Erin Douglas | Pediatrics | 801 Albany Street, 3rd Floor, Department of Pediatrics, Boston, MA 02119 | 2020-03-21 |
| 1720536568 | Ramy Y Barrett | Counselor | 77 Savin Street, Apartment # 3, Boston, MA 02119 | 2016-09-21 |
| 1083089676 | Natasha Cruz | Counselor | 263 Eustis Street, Roxbury, MA 02119 | 2015-12-08 |
| 1922478486 | Natalie Jones | Counselor | 520 Dudley St., Roxbury, MA 02119 | 2015-09-28 |
| 1922484799 | Dina Ghaly-habib | Student in an Organized Health Care Education/Training Program | 100 East Newton St., G-706, Boston, MA 02119 | 2015-08-04 |
| 1942697248 | Pyramid Builders | Case Management | 11 Roxbury Street, Boston, MA 02119 | 2015-04-24 |
| 1063810984 | Sophia Smalls | Counselor | 250 Walnut Ave, Apt. 10, Boston, MA 02119 | 2014-12-09 |
| 1750705059 | Alasa Hawkins | Counselor | 502 Dudley St, Roxbury, MA 02119 | 2014-02-07 |
| Find all providers in zip 02119 | ||||
| Taxonomy Code | 207QA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Addiction Medicine |
| A family medicine physician who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578062758 | Robynne Brown | Family Medicine | 59 Coddington St Ste 103, Quincy, MA 02169-4510 | 2018-02-02 |
| 1528353612 | Preventive Medicine Associates | Family Medicine | 154 Lynnway, Suite 1c, Lynn, MA 01902-3479 | 2011-06-16 |
| 1568760601 | Preventive Medicine Associates | Family Medicine | 501b Washington St, Dorchester Center, MA 02124-2014 | 2011-03-13 |
| 1962705251 | Preventive Medicine Associates | Family Medicine | 9 Henshaw St, Brighton, MA 02135-2905 | 2010-12-08 |
| 1326350976 | Preventive Medicine Associates | Family Medicine | 360 Coggeshall St, New Bedford, MA 02746-1923 | 2010-07-12 |
| 1689900565 | Preventive Medicine Associates | Family Medicine | 322 Gifford St, Falmouth, MA 02540 | 2009-10-27 |
| 1962641159 | Preventive Medicine Associates | Family Medicine | 63 Winthrop St, # C1, C2, Taunton, MA 02780-6218 | 2009-02-11 |
| 1356507511 | Preventive Medicine Associates | Family Medicine | 98 Suffolk St, Holyoke, MA 01040-4458 | 2008-08-06 |
| 1194949073 | Vineyard Healthcare Assoc. | Family Medicine | 455 State Rd Ste 13, Vineyard Haven, MA 02568-5621 | 2007-04-12 |
| 1063585370 | John M F Costa | Family Medicine | 42 Lands End Way, Swansea, MA 02777-2910 | 2006-11-16 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on PREVENTIVE MEDICINE ASSOCIATES.
| 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.