BROCKTON PEDIATRICS
NPI 1629001904
Clinic/Center - Primary Care in Brockton, MA
About Brockton Pediatrics NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BROCKTON PEDIATRICS (NPI 1629001904) is a healthcare organization registered as a primary care in Brockton, Massachusetts and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through April 25, 2028 and lists Yara Fernandez, Md, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Brockton Pediatrics is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
4Medicare enrollment records show 4 clinicians reassign Medicare billing to Brockton Pediatrics, which bills Medicare for the services they deliver. Of these, 4 practice at this address. They are listed nearest first.
Clinicians, nearest first (4)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
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 22D0080539
Brockton Pediatrics Inc · Brockton, MAFrequently 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 Brockton Pediatrics's NPI number?
The NPI number for Brockton Pediatrics is 1629001904. It was assigned to this organization in the NPPES registry on July 9, 2006.
Where is Brockton Pediatrics located?
Brockton Pediatrics is located at 65 Libby St, Brockton, MA 02302. The listed phone number is (508) 584-6060.
What is Brockton Pediatrics's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Brockton Pediatrics enrolled in Medicare?
Yes. Brockton Pediatrics is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Brockton Pediatrics?
According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians reassign their Medicare billing to Brockton Pediatrics, in Internal Medicine, Nurse Practitioner and Pediatric Medicine. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 4 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Brockton Pediatrics hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 22D0080539) is associated with this NPI, valid through April 25, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Brockton Pediatrics was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Brockton Pediatrics · NPI 1629001904
Primary Care organization in Brockton, Massachusetts. Organization record, active in the CMS NPPES registry since July 9, 2006.
## Identity
- **NPI:** 1629001904 (Entity type: Organization)
- **Enumerated:** July 9, 2006
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Yara Fernandez, MD
## Practice location
- **Address:** 65 LIBBY ST, Brockton, MA 02302-2949
- **Phone:** (508) 584-6060
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 4 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Pediatric Medicine (2), Internal Medicine (1), Nurse Practitioner (1); 4 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 22, 2020
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1629001904) · Data from the CMS NPPES public registry.