Provider Demographics
NPI:1154866234
Name:BAYON MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:BAYON MEDICAL GROUP LLC
Other - Org Name:LYNN PRIMARY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BATRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:857-452-6356
Mailing Address - Street 1:280 UNION ST STE 402
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1353
Mailing Address - Country:US
Mailing Address - Phone:781-780-7755
Mailing Address - Fax:781-598-0243
Practice Address - Street 1:280 UNION ST # 402
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1353
Practice Address - Country:US
Practice Address - Phone:781-780-7755
Practice Address - Fax:781-598-0243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 207Q00000X, 363LP0808X
MA222926261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110120791AMedicaid
MA110120791BMedicaid
MA35626OtherHEALTH NEW ENGLAND
MA0036690OtherNHP
MAJ28186OtherHMO BLUE (MANAGED CARE)
MAJ28186OtherBC/BS OF MA
MAJ28186OtherBLUE CARD ELECT
MAJ28186OtherBC/BS OF MA
MAL18738Medicare PIN