Basic Information
| Provider Information | |||||||||
| NPI: | 1750360798 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE MERCY HOSPITAL INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MERCY REHABILITATION HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 414432 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022414432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137489000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 271 CAREW ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137489000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL DIRECTOR OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 8607144396 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE MERCY HOSPITAL INC | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | 35 | MA | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QR0400X | 35 | MA | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | 282N00000X | 35 | MA | N | Hospitals | General Acute Care Hospital | 273Y00000X | 35 | MA | Y | Hospital Units | Rehabilitation Unit |
ID Information
| ID | Type | State | Issuer | Description | 110027346G | 05 | MA | MEDICAID | 3032356 | 05 | CT | MEDICAID | 2222006601 | 01 | MA | BLUE CROSS OF MASS. INPT | OTHER | 110027346E | 05 | MA | MEDICAID | 3023942 | 05 | CT | MEDICAID | 2222006610 | 01 | MA | BLUE CROSS OF MASS. OUTPT | OTHER |