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  7. NPI Record 1609821990

RIVERBEND MEDICAL GROUP
Complete NPI Record 1609821990
Internal Medicine in Chicopee, MA

NPI Status: Active since May 24, 2006

Contact Information

1109 GRANBY RD
CHICOPEE, MA
ZIP 01020
Phone: (413) 523-0814
Fax: (413) 523-0830

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Middle Name
  26. Authorized Official Title or Position
  27. Authorized Official Telephone Number
  28. Healthcare Provider Taxonomy Code 1
  29. Healthcare Provider Primary Taxonomy Switch 1
  30. Healthcare Provider Taxonomy Code 2
  31. Healthcare Provider Primary Taxonomy Switch 2
  32. Healthcare Provider Taxonomy Code 3
  33. Healthcare Provider Primary Taxonomy Switch 3
  34. Healthcare Provider Taxonomy Code 4
  35. Healthcare Provider Primary Taxonomy Switch 4
  36. Healthcare Provider Taxonomy Code 5
  37. Healthcare Provider Primary Taxonomy Switch 5
  38. Healthcare Provider Taxonomy Code 6
  39. Healthcare Provider Primary Taxonomy Switch 6
  40. Healthcare Provider Taxonomy Code 7
  41. Healthcare Provider Primary Taxonomy Switch 7
  42. Healthcare Provider Taxonomy Code 8
  43. Healthcare Provider Primary Taxonomy Switch 8
  44. Healthcare Provider Taxonomy Code 9
  45. Healthcare Provider Primary Taxonomy Switch 9
  46. Healthcare Provider Taxonomy Code 10
  47. Healthcare Provider Primary Taxonomy Switch 10
  48. Healthcare Provider Taxonomy Code 11
  49. Healthcare Provider Primary Taxonomy Switch 11
  50. Healthcare Provider Taxonomy Code 12
  51. Healthcare Provider Primary Taxonomy Switch 12
  52. Healthcare Provider Taxonomy Code 13
  53. Healthcare Provider Primary Taxonomy Switch 13
  54. Other Provider Identifier 1
  55. Other Provider Identifier Type Code 1
  56. Other Provider Identifier State 1
  57. Other Provider Identifier 2
  58. Other Provider Identifier Type Code 2
  59. Other Provider Identifier State 2
  60. Is Organization Subpart
  61. Authorized Official Credential Text
  62. Healthcare Provider Taxonomy Group 1
  63. Healthcare Provider Taxonomy Group 2
  64. Healthcare Provider Taxonomy Group 3
  65. Healthcare Provider Taxonomy Group 4
  66. Healthcare Provider Taxonomy Group 5
  67. Healthcare Provider Taxonomy Group 6
  68. Healthcare Provider Taxonomy Group 7
  69. Healthcare Provider Taxonomy Group 8
  70. Healthcare Provider Taxonomy Group 9
  71. Healthcare Provider Taxonomy Group 10
  72. Healthcare Provider Taxonomy Group 11
  73. Healthcare Provider Taxonomy Group 12
  74. Healthcare Provider Taxonomy Group 13

Complete NPI Dataset

This page represents the complete record for NPI 1609821990. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1609821990
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: RIVERBEND MEDICAL GROUP
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 3
The city name in the location address of the provider being identified.
Provider First Line Business Mailing Address: 1109 GRANBY RD
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: CHICOPEE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: MA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 010201568
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 4135230814
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 4135230830
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 1109 GRANBY RD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: CHICOPEE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: MA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 010201568
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 4135230814
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 4135230830
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 5/24/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 3/4/2016
The date that a record was last updated or changed.
Authorized Official Last Name: SHUMAN
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: RICHARD
The first name of the authorized official.
Authorized Official Middle Name: A
The middle name of the authorized official.
Authorized Official Title or Position: PRESIDENT
The title or position of the authorized official.
Authorized Official Telephone Number: 4135230814
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 103T00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 207RG0100X
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 207RR0500X
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 208600000X
Healthcare Provider Primary Taxonomy Switch 4: N
Healthcare Provider Taxonomy Code 5: 207W00000X
Healthcare Provider Primary Taxonomy Switch 5: N
Healthcare Provider Taxonomy Code 6: 207RP1001X
Healthcare Provider Primary Taxonomy Switch 6: N
Healthcare Provider Taxonomy Code 7: 207V00000X
Healthcare Provider Primary Taxonomy Switch 7: N
Healthcare Provider Taxonomy Code 8: 207RH0003X
Healthcare Provider Primary Taxonomy Switch 8: N
Healthcare Provider Taxonomy Code 9: 208000000X
Healthcare Provider Primary Taxonomy Switch 9: N
Healthcare Provider Taxonomy Code 10: 111N00000X
Healthcare Provider Primary Taxonomy Switch 10: N
Healthcare Provider Taxonomy Code 11: 2084P0800X
Healthcare Provider Primary Taxonomy Switch 11: N
Healthcare Provider Taxonomy Code 12: 2085R0202X
Healthcare Provider Primary Taxonomy Switch 12: N
Healthcare Provider Taxonomy Code 13: 207R00000X
Healthcare Provider Primary Taxonomy Switch 13: Y
Other Provider Identifier 1: 110022160/E
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: MA
Other Provider Identifier 2: 9782613
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: MA
Is Organization Subpart: N
Authorized Official Credential Text: M.D.
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 5: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 6: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 7: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 8: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 9: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 10: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 11: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 12: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 13: 193200000X MULTI-SPECIALTY GROUP