RENAISSANCE PRIMARY CARE, LLC
NPI 1649729021
Internal Medicine in Southbridge, MA

Q: What is Renaissance Primary Care, LLC's NPI number?

The NPI number for Renaissance Primary Care, LLC is 1649729021. It was assigned to this organization in the NPPES registry on September 27, 2016.

Q: What is Renaissance Primary Care, LLC's specialty?

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

Active since September 27, 2016CLIA 22D2121440 · Waiver

11-15 SANDERSDALE ROAD, SOUTHBRIDGE, MA 01550(774) 420-2311(508) 519-0763 Get Directions Write a Review

NPPES record last updated: July 15, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 7, 2019, Feb 13, 2019, Nov 7, 2018 and 2 more (5 updates tracked since 2016).

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About Renaissance Primary Care, Llc NPPES

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

RENAISSANCE PRIMARY CARE, LLC (NPI 1649729021) is a healthcare organization registered as an internal medicine in Southbridge, Massachusetts and active in the NPI registry since September 2016. The organization holds a CLIA Waiver certificate valid through November 3, 2026, maintains a secondary practice location in West Springfield, and lists James Manuel, Psychologist, as its authorized official.

NPPES Registry Identity

NPI1649729021

Entity TypeOrganization

Primary Taxonomy207R00000X

Legal Business NameRENAISSANCE PRIMARY CARE, LLC

Location Address11-15 SANDERSDALE ROADSouthbridge, MA 01550

Mailing Address11-15 Sandersdale RoadSouthbridge, MA 01550 · (774) 420-2311 · Fax (508) 519-0763

Phone(774) 420-2311

Fax(508) 519-0763

Organization SubpartNo

Authorized OfficialJames ManuelPsychologist · (774) 420-2311

Enumeration DateSeptember 27, 2016

Last NPPES UpdateJuly 15, 20255 updates tracked since enumeration

NPPES CertifiedJuly 15, 2025

✔ NPI 1649729021 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ 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 ListedCounselor · Mental HealthTaxonomy 101YM0800X

Also ListedPsychologistTaxonomy 103T00000X

Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X

Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X

11-15 SANDERSDALE ROAD, Southbridge, MA 01550

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Secondary Practice Location 1

Location 1112 Westfield StWest Springfield, MA 01089-2577 · Phone (774) 340-8791 · Fax (508) 519-0763

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

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 22D2121440

Renaissance Primary Care, LLC · Southbridge, MA

Active · expires Nov 3, 2026

CLIA Number22D2121440

Laboratory TypePhysician Office

Certificate Effective DateNovember 4, 2024

Certificate Expiration DateNovember 3, 2026

Laboratory DirectorDr. Sara B. Gallant

Laboratory Phone(774) 420-2311

Laboratory LocationRenaissance Primary Care, LLC11-15 Sandersdale Rd, Southbridge, MA 01550

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

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

RENAISSANCE MEDICAL GROUP, LLC

Community/Behavioral Health