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SIGNATURE MEDICAL GROUP
NPI 1063655017
Internal Medicine in Brockton, MA

Active since April 07, 2009CLIA Certified · 3 labs
680 CENTRE ST, BROCKTON, MA 02302(508) 941-7007(508) 941-6338 Get Directions Write a Review

NPPES record last updated: April 7, 2009. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Signature Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SIGNATURE MEDICAL GROUP (NPI 1063655017) is a healthcare organization registered as an internal medicine in Brockton, Massachusetts and active in the NPI registry since April 2009. The organization holds 3 active CLIA laboratory certificates and lists Eugene Wallace, Cfo, as its authorized official.

NPPES Registry Identity

NPI1063655017
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameSIGNATURE HEALTHCARE MEDICAL GROUP
Location Address680 CENTRE STBrockton, MA 02302-3308
Mailing Address680 Centre StBrockton, MA 02302-3308 · (508) 941-7007 · Fax (508) 941-6338
Phone(508) 941-7007
Fax(508) 941-6338
Organization SubpartYesParent: Signature Healthcare Corporation
Authorized OfficialEugene WallaceCfo · (508) 941-7007
Enumeration DateApril 7, 2009
✔ NPI 1063655017 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 15

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Also ListedEmergency MedicineTaxonomy 207P00000X
Also ListedInternal Medicine · Cardiovascular DiseaseTaxonomy 207RC0000X
Also ListedInternal Medicine · Endocrinology, Diabetes & MetabolismTaxonomy 207RE0101X
Also ListedInternal Medicine · GastroenterologyTaxonomy 207RG0100X
Also ListedInternal Medicine · Geriatric MedicineTaxonomy 207RG0300X
Also ListedInternal Medicine · Infectious DiseaseTaxonomy 207RI0200X
Also ListedInternal Medicine · NephrologyTaxonomy 207RN0300X
Also ListedInternal Medicine · Pulmonary DiseaseTaxonomy 207RP1001X
Also ListedObstetrics & GynecologyTaxonomy 207V00000X
Also ListedOrthopaedic SurgeryTaxonomy 207X00000X
Also ListedPediatricsTaxonomy 208000000X
Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X
Also ListedSurgeryTaxonomy 208600000X
Also ListedHospitalistTaxonomy 208M00000X
680 CENTRE ST, Brockton, MA 02302
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Other Names 1

Doing Business AsSignature Medical Group

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 22D2305821

Signature Medical Group · Brockton, MA
Active · expires Jun 5, 2028
CLIA Number22D2305821
Laboratory TypePhysician Office
Certificate Effective DateJune 6, 2026
Certificate Expiration DateJune 5, 2028
Laboratory DirectorMark Franciosa
Laboratory Phone(508) 941-7000
Laboratory LocationSignature Medical Group650 Centre Street, Brockton, MA 02302
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 22D0726395

Signature Medical Group · Brockton, MA
Active · expires May 7, 2027
CLIA Number22D0726395
Laboratory TypePhysician Office
Certificate Effective DateMay 8, 2025
Certificate Expiration DateMay 7, 2027
Laboratory DirectorMark Franciosa
Laboratory Phone(508) 941-7000
Laboratory LocationSignature Medical Group176/178 Quincy Ave, Brockton, MA 02302
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 22D2198967

Signature Medical Group · Brockton, MA
Active · expires Nov 3, 2026
CLIA Number22D2198967
Laboratory TypePhysician Office
Certificate Effective DateNovember 4, 2024
Certificate Expiration DateNovember 3, 2026
Laboratory DirectorMark Franciosa
Laboratory Phone(508) 941-7000
Laboratory LocationSignature Medical Group110 Liberty St Ste 2A, 2B, 2C, 3B, 3C, Brockton, MA 02302
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LOUIS D. GOTTLIEB M.D.
Internal Medicine
680 CENTRE ST, MANAGED CARE
BROCKTON, MA 02302
Plymouth County (508) 941-7065
MS. JAMIE CHYAT PA-C
Physician Assistant
680 CENTRE ST
BROCKTON, MA 02302
Plymouth County (508) 941-7000
BRANDEN M TURNER LMHC
Counselor (Mental Health)
680 CENTRE ST
BROCKTON, MA 02302
Plymouth County (508) 941-7228
CARLY ALEXANDRA CARLIN MD
Psychiatry & Neurology (Psychiatry)
680 CENTRE ST
BROCKTON, MA 02302
Plymouth County (508) 941-7228
DR. ANGEL TAYLOR MD
Student in an Organized Health Care Education/Training Program
680 CENTRE ST
BROCKTON, MA 02302
Plymouth County (508) 974-7000
DR. DESIREE A CARLSON MD
Pathology (Anatomic Pathology & Clinical Pathology)
680 CENTRE ST, PATHOLOGY DEPARTMENT
BROCKTON, MA 02302
Plymouth County (508) 941-7414
DEMIN MA M.D.
Psychiatry & Neurology (Psychiatry)
680 CENTRE ST
BROCKTON, MA 02302
Plymouth County (508) 941-7228
JENNIFER L. BUNKER
Social Worker
680 CENTRE ST
BROCKTON, MA 02302
Plymouth County (508) 941-7268

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Signature Healthcare Medical Group's NPI number?

The NPI number for Signature Healthcare Medical Group is 1063655017. It was assigned to this organization in the NPPES registry on April 7, 2009. The provider is doing business as Signature Medical Group.

Where is Signature Healthcare Medical Group located?

Signature Healthcare Medical Group is located at 680 Centre St, Brockton, MA 02302. The listed phone number is (508) 941-7007.

What is Signature Healthcare Medical Group's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Signature Healthcare Medical Group hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Signature Healthcare Medical Group was last updated on April 7, 2009. NPI Profile syncs with the weekly NPPES data releases published by CMS.