Basic Information
| Provider Information | |||||||||
| NPI: | 1518918598 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRIMMER | ||||||||
| FirstName: | OKSANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROGERSON | ||||||||
| OtherFirstName: | OKSANA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5 NEPONSET ST FL STREET2 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087211170 | ||||||||
| FaxNumber: | 5088320859 | ||||||||
| Practice Location | |||||||||
| Address1: | 385 SOUTHBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015012498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087211170 | ||||||||
| FaxNumber: | 5088320859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2006 | ||||||||
| LastUpdateDate: | 03/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 220575 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 1667164 | 01 | CIGNA HEALTH PLAN | OTHER | 0407079 | 01 | EVERCARE | OTHER | 784178 | 01 | MVP HEALTH CARE | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 419318 | 01 | TUFTS HEALTH PLAN | OTHER | 91200 | 01 | FALLON COMMUNITY HEALTH | OTHER | 042472266 | 01 | UNITED HEALTHCARE | OTHER | J28269 | 01 | BLUE SHIELD HMO BLUE | OTHER | 2080796 | 05 | MA | MEDICAID | 7339615 | 01 | AETNA US HEALTHCARE | OTHER | AA16904 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | J28269 | 01 | BLUE SHIELD INDEMNITY | OTHER | J28269 | 01 | BLUE CARE ELECT | OTHER |