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  7. NPI Record 1750486106

CHARLES RIVER COMMUNITY HEALTH, INC
Complete NPI Record 1750486106
Clinic/Center - Federally Qualified Health Center (FQHC) in Waltham, MA

NPI Status: Active since September 13, 2006

Contact Information

43 FOUNDRY AVE
WALTHAM, MA
ZIP 02453
Phone: (617) 783-0500

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Enumeration Date
  19. Last Update Date
  20. Authorized Official Last Name
  21. Authorized Official First Name
  22. Authorized Official Title or Position
  23. Authorized Official Telephone Number
  24. Healthcare Provider Taxonomy Code 1
  25. Provider License Number 1
  26. Provider License Number State Code 1
  27. Healthcare Provider Primary Taxonomy Switch 1
  28. Other Provider Identifier 1
  29. Other Provider Identifier Type Code 1
  30. Other Provider Identifier State 1
  31. Other Provider Identifier Issuer 1
  32. Other Provider Identifier 2
  33. Other Provider Identifier Type Code 2
  34. Other Provider Identifier State 2
  35. Other Provider Identifier Issuer 2
  36. Other Provider Identifier 3
  37. Other Provider Identifier Type Code 3
  38. Other Provider Identifier State 3
  39. Other Provider Identifier 4
  40. Other Provider Identifier Type Code 4
  41. Other Provider Identifier State 4
  42. Other Provider Identifier Issuer 4
  43. Other Provider Identifier 5
  44. Other Provider Identifier Type Code 5
  45. Other Provider Identifier State 5
  46. Other Provider Identifier Issuer 5
  47. Other Provider Identifier 6
  48. Other Provider Identifier Type Code 6
  49. Other Provider Identifier State 6
  50. Other Provider Identifier Issuer 6
  51. Other Provider Identifier 7
  52. Other Provider Identifier Type Code 7
  53. Other Provider Identifier State 7
  54. Other Provider Identifier Issuer 7
  55. Other Provider Identifier 8
  56. Other Provider Identifier Type Code 8
  57. Other Provider Identifier State 8
  58. Is Organization Subpart
  59. Authorized Official Name Prefix Text

Complete NPI Dataset

This page represents the complete record for NPI 1750486106. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1750486106
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 495 WESTERN AVE
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: BRIGHTON
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: MA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 021351007
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 7816933800
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 6179878222
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 43 FOUNDRY AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: WALTHAM
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: MA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 024538313
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 6177830500
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 9/13/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 3/17/2018
The date that a record was last updated or changed.
Authorized Official Last Name: BROWNE
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: ELIZABETH
The middle name of the provider, if the provider is an individual.
Authorized Official Title or Position: EXECUTIVE DIRECTOR
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Authorized Official Telephone Number: 6172051511
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Healthcare Provider Taxonomy Code 1: 261QF0400X
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider License Number 1: 4157
The city name in the mailing address of the provider being identified.
Provider License Number State Code 1: MA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Healthcare Provider Primary Taxonomy Switch 1: Y
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Other Provider Identifier 1: 2227002110
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: MA
Other Provider Identifier Issuer 1: BCBS
Other Provider Identifier 2: 682536
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: MA
Other Provider Identifier Issuer 2: TUFTS HEALTH PLAN - MED
Other Provider Identifier 3: 1320882
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: MA
Other Provider Identifier 4: 903699
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: MA
Other Provider Identifier Issuer 4: TUFTS HEALTH PLAN - MH
Other Provider Identifier 5: M12043
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: MA
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Other Provider Identifier Issuer 5: BCBS MEDICAL/PODIATRY
Other Provider Identifier 6: W20419
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6: MA
Other Provider Identifier Issuer 6: BCBS - OPTOMETRY
Other Provider Identifier 7: 686893
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: MA
Other Provider Identifier Issuer 7: TUFTS HEALTH PLAN
Other Provider Identifier 8: 110024306T
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 8: MA
Is Organization Subpart: N
Authorized Official Name Prefix Text: MRS.