| Codman Square Health Center, Inc | |
|
637 Washington St Dorchester Center MA 02124-3510 | |
| (617) 825-9660 | |
| (617) 288-7898 |
| Full Name | Codman Square Health Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 637 Washington St, Dorchester Center, Massachusetts |
| Authorized Official Name and Position | Sandra Cotterell (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6178259660 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Codman Square Health Center, Inc 637 Washington St Dorchester Center MA 02124-3510 Ph: (617) 825-9660 | Codman Square Health Center, Inc 637 Washington St Dorchester Center MA 02124-3510 Ph: (617) 825-9660 |
| NPI Number | 1396808309 |
|---|---|
| Provider Enumeration Date | 12/19/2006 |
| Last Update Date | 02/07/2023 |
| Medicare PECOS PAC ID | 8123013869 |
|---|---|
| Medicare Enrollment ID | O20040420000859 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396808309 | NPI | - | NPPES |
| 1211757 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
| Provider Name | Marie A Pierre-victor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043373921 PECOS PAC ID: 3577555200 Enrollment ID: I20040401000684 |
| Provider Name | Philip Severin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689635534 PECOS PAC ID: 5597756007 Enrollment ID: I20040523000002 |
| Provider Name | Victoria P Wolfson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194759597 PECOS PAC ID: 8022076611 Enrollment ID: I20041229000519 |
| Provider Name | Stephenson B Tobierre |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871579342 PECOS PAC ID: 7517913031 Enrollment ID: I20050329000111 |
| Provider Name | Donald M Foxworthy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558336289 PECOS PAC ID: 2466409073 Enrollment ID: I20050406000298 |
| Provider Name | Salvatore J Molica |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245393214 PECOS PAC ID: 5597703355 Enrollment ID: I20050421000808 |
| Provider Name | Vasken M Kroshian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225084924 PECOS PAC ID: 6305880659 Enrollment ID: I20050616001090 |
| Provider Name | Jonathan M Pincus |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043234099 PECOS PAC ID: 8729015235 Enrollment ID: I20050726000576 |
| Provider Name | Trinh Khuu |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1871593871 PECOS PAC ID: 8224069034 Enrollment ID: I20050822000944 |
| Provider Name | Hyasmine J Verdieu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902929938 PECOS PAC ID: 0840218731 Enrollment ID: I20051109000621 |
| Provider Name | Glen S Blair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629047873 PECOS PAC ID: 8123033503 Enrollment ID: I20060207000771 |
| Provider Name | Iris A Montijo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871754390 PECOS PAC ID: 8123034253 Enrollment ID: I20060228000159 |
| Provider Name | Monica M Joyce |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1336175389 PECOS PAC ID: 1254341316 Enrollment ID: I20060503000676 |
| Provider Name | Christine A Farrell Riley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992791883 PECOS PAC ID: 9931208659 Enrollment ID: I20070621000174 |
| Provider Name | Sharon R Sloan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578552014 PECOS PAC ID: 5193812766 Enrollment ID: I20071029000551 |
| Provider Name | Sara A Tepperberg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104816123 PECOS PAC ID: 2961565411 Enrollment ID: I20090110000028 |
| Provider Name | Thamarah Crevecoeur |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1326284233 PECOS PAC ID: 4789748153 Enrollment ID: I20090129000408 |
| Provider Name | Jared W Magnani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306996343 PECOS PAC ID: 0648329383 Enrollment ID: I20090528000507 |
| Provider Name | Susanna M Erber |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1174506141 PECOS PAC ID: 1759436231 Enrollment ID: I20090904000379 |
| Provider Name | Zinah S Abukhalil Quinonez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376662627 PECOS PAC ID: 4789730631 Enrollment ID: I20090918000229 |
| Provider Name | Rosha Nicole Forman |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1265683932 PECOS PAC ID: 6204974108 Enrollment ID: I20091113000329 |
| Provider Name | Timothy S Naimi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679572291 PECOS PAC ID: 1355335290 Enrollment ID: I20100122000120 |
| Provider Name | Jeanette M. Sewell |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1609969229 PECOS PAC ID: 0941498513 Enrollment ID: I20101223000247 |
| Provider Name | Rachel D Hindin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134163462 PECOS PAC ID: 9133123565 Enrollment ID: I20110124000315 |
| Provider Name | Amanda E Davis |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1295937308 PECOS PAC ID: 2264502905 Enrollment ID: I20110128000627 |
| Provider Name | Genevieve C Daftary |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1649439274 PECOS PAC ID: 8022287796 Enrollment ID: I20110815000309 |
| Provider Name | Carme D Ogando Saintil |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316101454 PECOS PAC ID: 9931372471 Enrollment ID: I20111028000601 |
| Provider Name | Jane F Tuitt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093879215 PECOS PAC ID: 0345414090 Enrollment ID: I20111116000067 |
| Provider Name | Stephen M Tringale |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669536116 PECOS PAC ID: 8022271709 Enrollment ID: I20120516000207 |
| Provider Name | Fuchsia Y Mitchell |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1922014364 PECOS PAC ID: 3476717216 Enrollment ID: I20120607000412 |
| Provider Name | Dana Rebecca Mars |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902178585 PECOS PAC ID: 4385806512 Enrollment ID: I20120830000672 |
| Provider Name | Justin C Ogbonna |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1952626483 PECOS PAC ID: 7911192471 Enrollment ID: I20121005000002 |
| Provider Name | Ian D Huntington |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467680652 PECOS PAC ID: 5193977445 Enrollment ID: I20121212000422 |
| Provider Name | Sundyna J Beaven |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1134392889 PECOS PAC ID: 0648425918 Enrollment ID: I20130313000213 |
| Provider Name | Kyla Aprn Biegun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407191372 PECOS PAC ID: 5193961043 Enrollment ID: I20130419000009 |
| Provider Name | Frederick Miller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083806343 PECOS PAC ID: 1951498252 Enrollment ID: I20130809000638 |
| Provider Name | Tarcia Edmunds-jehu |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1306946942 PECOS PAC ID: 0244453629 Enrollment ID: I20140604000185 |
| Provider Name | Eric L. Hwang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912299850 PECOS PAC ID: 6608008933 Enrollment ID: I20141024001312 |
| Provider Name | Debi Sarma |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1164825063 PECOS PAC ID: 4183947294 Enrollment ID: I20141222001510 |
| Provider Name | Wei M Tseng |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1548527518 PECOS PAC ID: 1052543097 Enrollment ID: I20150930002088 |
| Provider Name | Diane M Russo |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1174839146 PECOS PAC ID: 0345558920 Enrollment ID: I20150930003139 |
| Provider Name | Melissa Dagher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073922001 PECOS PAC ID: 3870801319 Enrollment ID: I20151001002177 |
| Provider Name | Emmanuel Bouloute |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942608674 PECOS PAC ID: 8022326461 Enrollment ID: I20151005000305 |
| Provider Name | Gillian Burkhardt |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1326214289 PECOS PAC ID: 7618285909 Enrollment ID: I20151007000245 |
| Provider Name | David M Washington |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851684955 PECOS PAC ID: 9436376837 Enrollment ID: I20160405001612 |
| Provider Name | Kathleen A Ireland |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1790924249 PECOS PAC ID: 9537254859 Enrollment ID: I20160831000381 |
| Provider Name | Darline Joseph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619244522 PECOS PAC ID: 0042439473 Enrollment ID: I20170113002247 |
| Provider Name | Jeannie M Baca |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174872147 PECOS PAC ID: 9739462979 Enrollment ID: I20170213002124 |
| Provider Name | Cassondra N Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831408194 PECOS PAC ID: 4183993090 Enrollment ID: I20170710001360 |
| Provider Name | Kelly M Treder |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1235558727 PECOS PAC ID: 7719277565 Enrollment ID: I20180628002053 |
| Provider Name | Sarah Bozogan Miller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235397506 PECOS PAC ID: 8325192552 Enrollment ID: I20190220001922 |
| Provider Name | Jessica E Isom |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417334863 PECOS PAC ID: 6305151119 Enrollment ID: I20190903002388 |
| Provider Name | Tamara Leroy-london |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427409465 PECOS PAC ID: 9739419599 Enrollment ID: I20190923001069 |
| Provider Name | Theresa F Clearman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144609793 PECOS PAC ID: 7911210174 Enrollment ID: I20191025001169 |
| Provider Name | Elizabeth M Moran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205494630 PECOS PAC ID: 3375977366 Enrollment ID: I20191227002316 |
| Provider Name | Monique L Anderson-mccurbin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881141836 PECOS PAC ID: 3577846872 Enrollment ID: I20200220001796 |
| Provider Name | Onyemaechi Chiekwue Onyekwu |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1164887477 PECOS PAC ID: 5496177404 Enrollment ID: I20200622000130 |
| Provider Name | Marta Escriu-sune |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891253795 PECOS PAC ID: 7618395666 Enrollment ID: I20200908003059 |
| Provider Name | Nnemdi O Azubuko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689295750 PECOS PAC ID: 0042630253 Enrollment ID: I20201008002474 |
| Provider Name | Khai-el Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831553080 PECOS PAC ID: 6709171341 Enrollment ID: I20201127000114 |
| Provider Name | Jasmine Welcome |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457888737 PECOS PAC ID: 9234541491 Enrollment ID: I20201210003111 |
| Provider Name | Renee M Crichlow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396731832 PECOS PAC ID: 9133110380 Enrollment ID: I20210803003366 |
| Provider Name | Jennifer J Vanderweele |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841682127 PECOS PAC ID: 9234489691 Enrollment ID: I20210805003095 |
| Provider Name | Stephanie E Kuntz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689056897 PECOS PAC ID: 0244661528 Enrollment ID: I20210916003123 |
| Provider Name | Sheri L Kimball |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1639848047 PECOS PAC ID: 6204234263 Enrollment ID: I20211006001875 |
| Provider Name | Devin N Cromartie Bodrick |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669904462 PECOS PAC ID: 8921379728 Enrollment ID: I20211020000434 |
| Provider Name | Kanisha Louis Jean |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790137024 PECOS PAC ID: 1355739418 Enrollment ID: I20211022002230 |
| Provider Name | Angela L Mclaughlin |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1154779932 PECOS PAC ID: 2769777267 Enrollment ID: I20211222001371 |
| Provider Name | Christa O Gumbs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386978146 PECOS PAC ID: 4284025073 Enrollment ID: I20220105002544 |
| Provider Name | Nichele Y Thompson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245599166 PECOS PAC ID: 9032506035 Enrollment ID: I20220421001035 |
| Provider Name | Luca Anna Koritsanszky |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1417697442 PECOS PAC ID: 6002295250 Enrollment ID: I20220620000874 |
| Provider Name | Tatiana A Lucien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477294098 PECOS PAC ID: 9830579432 Enrollment ID: I20220629000165 |
| Provider Name | Florence N Okonkwo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346979721 PECOS PAC ID: 3779950860 Enrollment ID: I20221102001505 |
| Provider Name | Dan Phuong T Nguyen |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1245692722 PECOS PAC ID: 2961872429 Enrollment ID: I20221228001893 |
| Provider Name | Dalia N Marmash |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1770201105 PECOS PAC ID: 1850762469 Enrollment ID: I20230118002339 |
| Provider Name | Martha Gargar Charley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609368919 PECOS PAC ID: 2961754940 Enrollment ID: I20230414000811 |
| Provider Name | Sam C Gonzalez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881199560 PECOS PAC ID: 1456600782 Enrollment ID: I20230705001910 |
| Provider Name | Cindy L Benavides |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598463655 PECOS PAC ID: 8123487378 Enrollment ID: I20230706000535 |
| Provider Name | Thatiana Jeune |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417520636 PECOS PAC ID: 1557724242 Enrollment ID: I20230829000558 |
| Provider Name | Cathyana Jean-baptiste |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689362683 PECOS PAC ID: 6800259516 Enrollment ID: I20230829001737 |
| Provider Name | Anh V Bui |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1891363644 PECOS PAC ID: 3476930454 Enrollment ID: I20230830002958 |
| Provider Name | Stephanie M Adcock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295362192 PECOS PAC ID: 3173942810 Enrollment ID: I20230914000868 |
| Provider Name | Jessica Pierre Francois |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1285262089 PECOS PAC ID: 9739522020 Enrollment ID: I20240202002619 |
| Provider Name | Ruth Manu |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669099503 PECOS PAC ID: 0941647820 Enrollment ID: I20240327002583 |
Thomas J Kenney Md Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2110 Dorchester Ave, Suite 210, Dorchester Center, MA 02124 Phone: 617-296-9510 |