MEDICARE: UMASS MEMORIAL MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1093670515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UMASS MEMORIAL MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	P.O. BOX 415348
Second Line	:	ATTN: PROVIDER ENROLLMENT
City	:	BOSTON
State	:	MA
Zip	:	02241
Country	:	US
Telephone Number	:	508-334-8015
Fax Number	:	508-334-8105

Provider Business Practice Location Address
First Line	:	194 WEST ST STE 10
Second Line	:
City	:	MILFORD
State	:	MA
Zip	:	01757-2274
Country	:	US
Telephone Number	:	508-381-6590
Fax Number	:	508-381-6593

Authorized Official
Title or Position	:	DIRECTOR, MEDICAL STAFF SERVICES
Name	:	ANDREW SCIANNAMEO
Credential	:
Telephone Number	:	508-450-0098

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/29/2025

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