Healthcare Provider Details

I. General information

NPI: 1003607193
Provider Name (Legal Business Name): BLUE CROSS BLUE SHIELD OF MASSACHUSETTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HUNTINGTON AVE STE 1300
BOSTON MA
02199-7611
US

IV. Provider business mailing address

53 WOODBINE RD
STOUGHTON MA
02072-1772
US

V. Phone/Fax

Practice location:
  • Phone: 617-246-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: JOANNA FARRELL
Title or Position: MEDICAL POLICY SPECIALIST
Credential: RN
Phone: 617-470-2541