Provider Demographics
NPI:1376595470
Name:CHELSEA MRI PC
Entity Type:Organization
Organization Name:CHELSEA MRI PC
Other - Org Name:THE MRI CENTER OF SPRINGFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTAMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-569-6541
Mailing Address - Street 1:800 W CUMMINGS PARK
Mailing Address - Street 2:SUITE 1350
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6372
Mailing Address - Country:US
Mailing Address - Phone:781-569-6541
Mailing Address - Fax:781-569-6557
Practice Address - Street 1:3640 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1145
Practice Address - Country:US
Practice Address - Phone:413-781-9000
Practice Address - Fax:413-781-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
MA261QM1200X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)Group - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110028942/AMedicaid
MA110028942/DMedicaid
MAM17165OtherBC BS PROFESSIONAL #
MA034869OtherBC BS OF MA TECHNICAL #
MA110028942/CMedicaid
MA110028942/BMedicaid
MA110028942/DMedicaid
MAM17165OtherBC BS PROFESSIONAL #
MA0004384Medicare PIN
MA000438403Medicare PIN