CENTRAL MASSACHUSETTS MAGNETIC IMAGING CENTER, INC. (NPI# 1669786323) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669786323 |
| Entity Type | Organization |
| Organization Name | CENTRAL MASSACHUSETTS MAGNETIC IMAGING CENTER, INC. |
| Practice Address |
55 Lake Ave N Suite H1-713 Worcester MA 01655-0002 |
| Mailing Address |
367 Plantation St Worcester MA 01605-2323 |
| Practice Telephone | 7744430500 |
| Practice Fax Number | 5088313715 |
| Mailing Telephone | 5087546026 |
| Mailing Fax Number | 5088313715 |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2010-08-04 |
| Authorized Official Name | MR. JEFFREY L POLLIER (DIRECTOR) |
| Authorized Official Telephone | 5087546026 |
| Is Organization Subpart | Y |
| Parent Organization Name | CENTRAL MASSACHUSETTS MAGNETIC IMAGING CENTER, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1200X |
Clinic/Center Specialization: Magnetic Resonance Imaging (MRI) |
4359 | MA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 1529676 | 05 |
| Street Address |
55 LAKE AVE N SUITE H1-713 |
| City | WORCESTER |
| State | MA |
| Zip Code | 01655-0002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477556587 | James E Liebmann | Internal Medicine | 55 Lake Ave N, Hematology/oncology, Worcester, MA 01655-0002 | 2005-05-23 |
| 1518568732 | Justin Bullard | Psychologist | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-11-04 |
| 1346849825 | Meghan Moore | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-10-26 |
| 1174122899 | Jessica Goncalves Ferreira | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-10-23 |
| 1235746686 | Desiree Mytych | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-09-29 |
| 1659986248 | Rebecca Lynn Harris | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-09-10 |
| 1639781487 | Gabriella Kathleen Holland | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-21 |
| 1730791898 | Kerry Anne Benedict | Speech-Language Pathologist | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-20 |
| 1902418999 | Natasha R. Turner | Genetic Counselor, MS | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-20 |
| 1144830712 | Abbey Corsini | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205489713 | Darryl Sweeper Jr. | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Psychiatry, Umass Memorial Medical Center, Worcester, MA 01655 | 2019-07-23 |
| 1225690530 | Ryan Zenevitch | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Family Medicine, Umass Memorial Medical Center, Worcester, MA 01655 | 2019-07-08 |
| 1932688454 | Victoria Sayeg | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Pediatrics, Worcester, MA 01655 | 2018-08-07 |
| 1114425675 | Judith Dio Wentzell | Social Worker | Umassmemorial Medical Center, 55 Lake Ave North, Dept of Care Coordination, Worcester, MA 01655 | 2018-01-30 |
| 1861927386 | Muhammad Waqas Khan | Student in an Organized Health Care Education/Training Program | University of Massachusetts 55 North Lake Ave, Neurology, Worcester, MA 01655 | 2017-04-21 |
| 1861806192 | Qaiser Shamshir Khan | Psychiatry & Neurology | 55 Lake Ave N # S7-831, Worcester, MA 01655 | 2014-06-14 |
| 1073858981 | Heidi Glover | Nurse Practitioner | 55 Lake Ave North Dept. of Pedi-adolescent, Ummc University Campus, Worcester, MA 01655 | 2012-12-04 |
| 1972867992 | Anna Bjornsdottir | Psychiatry & Neurology | 55 Lake Av N, Worcester, MA 01655 | 2012-06-25 |
| 1245567676 | Steven Edward Mckinley | Nurse Practitioner | 55 Lake Ave. North, Umass Memorial Medical Center University Campus, Worcester, MA 01655 | 2009-11-05 |
| 1851582951 | Robin I Davidson | Neurological Surgery | 55 Lake Ave, North, Ummhc-univ Campus, Worcester, MA 01655 | 2007-08-05 |
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| Taxonomy Code | 261QM1200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Magnetic Resonance Imaging (MRI) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619446325 | Umass Memorial Mri & Imaging Center, LLC | Clinic/Center | 55 Lake Ave N Ste H1-351a, Worcester, MA 01655-0002 | 2018-11-26 |
| 1245654557 | Umass Memorial Mri & Imaging Center LLC | Clinic/Center | 55 Lake Ave N Ste H1-713b, Worcester, MA 01655-0002 | 2014-02-06 |
| 1609952845 | Central Massachusetts Magnetic Imaging Center Inc | Clinic/Center | 367 Plantation Street, Worcester, MA 01605 | 2006-10-31 |
| 1053648956 | Khashayar Rafatzand | Clinic/Center | 55 Lake Ave N, S2-824, Worcester, MA 01655-0002 | 2009-11-13 |
| 1437247244 | Aurora Breast Mri of Central Massachusetts, LLC | Clinic/Center | 67 Belmont St, Worcester, MA 01605-2657 | 2006-10-10 |
| 1700835592 | Umass Memorial Mri & Imaging Center, LLC | Clinic/Center | 119 Belmont St, Worcester, MA 01605-2903 | 2006-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134764186 | Winchester Hospital - Shields Mri LLC | Clinic/Center | 41 Highland Ave Ste G1, Winchester, MA 01890-1446 | 2019-11-14 |
| 1073801551 | Umass Memorial Mri & Imaging Center, LLC | Clinic/Center | 28 Newton Street, Southborough, MA 01772-1215 | 2011-07-18 |
| 1902855489 | Fall River/new Bedford Regional Mri Limited Partnership | Clinic/Center | 361 Allen St, New Bedford, MA 02740-2107 | 2006-05-10 |
| 1285683474 | Shields Mri & Imaging Center of Cape Cod, LLC | Clinic/Center | 2 Iyanough Rd, Route 28, W Yarmouth, MA 02673-8135 | 2006-05-08 |
| 1144279274 | South Shore Mri, Limited Partnership | Clinic/Center | 26 Rockway Ave, Weymouth, MA 02188-3906 | 2006-05-08 |
| 1831148014 | Massachusetts Bay Regional Mri Limited Partnership | Clinic/Center | 161 Granite Ave, Dorchester Center, MA 02124-5453 | 2006-05-08 |
| 1730138868 | Shields Mri of Framingham, LLC | Clinic/Center | 14 Cochituate Rd, Framingham, MA 01701-7915 | 2006-05-08 |
| 1134178346 | Fall River-new Bedford Regional Mri, Limited Partnership | Clinic/Center | 313 Faunce Corner Rd, Dartmouth, MA 02747-1252 | 2006-05-08 |
| 1992156772 | Western Massachusetts Magnetic Resonance Services LLC | Clinic/Center | 444 Montgomery St, Chicopee, MA 01020-1969 | 2016-06-23 |
| 1366871469 | Shields Imaging of Lowell General Hospital LLC | Clinic/Center | 1 Hospital Dr, Lowell, MA 01852-1311 | 2013-11-08 |
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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.