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1295787919

NPI Code Detail

MEDICARE: MASS GENERAL BRIGHAM MEDICAL GROUP WESTERN MASSACHUSETTS INC

MEDICARE: MASS GENERAL BRIGHAM MEDICAL GROUP WESTERN MASSACHUSETTS 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	207LH0002X	Hospice and Palliative Medicine (Anesthesiology) Physician		MA
2	207R00000X	Internal Medicine Physician
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician
4	207RH0003X	Hematology & Oncology Physician
5	207RI0200X	Infectious Disease Physician
6	207V00000X	Obstetrics & Gynecology Physician
7	208000000X	Pediatrics Physician
8	208100000X	Physical Medicine & Rehabilitation Physician
9	208200000X	Plastic Surgery Physician
10	2084P0800X	Psychiatry Physician
11	2085R0204X	Vascular & Interventional Radiology Physician
12	208600000X	Surgery Physician
13	213E00000X	Podiatrist
14	332B00000X	Durable Medical Equipment & Medical Supplies
15	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ0816	OTHER	MA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	M15904	OTHER	MA	BLUE CROSS BLUE SHIELD OF MASSACHUSETTS
3	614074	OTHER	MA	TUFTS HEALTH PLAN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	617074	OTHER	MA	TUFTS HEALTH PLAN
6	M15904	OTHER	MA	BCBS OF MASS

General Provider Information

NPI Number	:	1295787919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASS GENERAL BRIGHAM MEDICAL GROUP WESTERN MASSACHUSETTS INC

Provider Business Mailing Address
First Line	:	399 REVOLUTION DR
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02145-1484
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 LOCUST ST
Second Line	:
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-2052
Country	:	US
Telephone Number	:	413-582-2898
Fax Number	:	413-582-2958

Authorized Official
Title or Position	:	PRESIDENT & COO
Name	:	LINDSAY GAINER
Credential	:
Telephone Number	:	857-282-3914

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	06/02/2025

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Directions to “MASS GENERAL BRIGHAM MEDICAL GROUP WESTERN MASSACHUSETTS INC ” Practice Location

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