{"npi":"1780780486","type":"NPI-2","status":"active","name":{"display":"Upham's Corner Health Committee, Inc.","other":[],"organization_name":"UPHAM'S CORNER HEALTH COMMITTEE, INC.","authorised_official":"Jagdeep Trivedi"},"specialty":{"primary_taxonomy":"261QC1500X","primary_taxonomy_description":"Community Health Clinic/Center","slug":"community-health-clinic-center","schema_org_specialty":null,"all":[{"code":"261QD0000X","description":"Dental Clinic/Center","primary":false,"state":null,"license":null},{"code":"261QF0050X","description":"Non-Surgical Family Planning Clinic/Center","primary":false,"state":null,"license":null},{"code":"261QF0400X","description":"Federally Qualified Health Center","primary":false,"state":"MA","license":"490"},{"code":"261QM0801X","description":"Mental Health Clinic/Center (Including Community Mental Health Center)","primary":false,"state":null,"license":null},{"code":"261QM2500X","description":"Medical Specialty Clinic/Center","primary":false,"state":null,"license":null},{"code":"261QP1100X","description":"Podiatric Clinic/Center","primary":false,"state":null,"license":null},{"code":"261QP2300X","description":"Primary Care Clinic","primary":false,"state":null,"license":null},{"code":"261QU0200X","description":"Urgent Care","primary":false,"state":null,"license":null},{"code":"291U00000X","description":"Clinical Medical Laboratory","primary":false,"state":null,"license":null},{"code":"292200000X","description":"Dental Laboratory","primary":false,"state":null,"license":null},{"code":"261QC1500X","description":"Community Health Clinic/Center","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"500 COLUMBIA RD","city":"DORCHESTER","state":"MA","postal_code":"021252322","country_code":"US","phone":"6172878000","fax":"6172828625"},{"purpose":"MAILING","street_1":"500 COLUMBIA RD","city":"DORCHESTER","state":"MA","postal_code":"021252322","country_code":"US","phone":"6172878000","fax":"6172828625"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"1301977","state":"MA","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20060508000841","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"MA","pac_id":"4284645086"},{"enrlmt_id":"O20100426000035","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"MA","pac_id":"4284645086"},{"enrlmt_id":"O20151118001892","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"MA","pac_id":"4284645086"},{"enrlmt_id":"O20151118002748","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"MA","pac_id":"4284645086"}]},"enumeration_date":"2006-09-16","last_updated":"2017-07-12","_meta":{"source":"NPPES","snapshot_date":"2017-07-12","doc_url":"https://findmynpi.com/api"}}