Provider Demographics
NPI:1922009547
Name:WESTERN MASS PHYSICIAN ASSOCIATES INC
Entity Type:Organization
Organization Name:WESTERN MASS PHYSICIAN ASSOCIATES INC
Other - Org Name:HOLYOKE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF AMBULATORY SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-534-2622
Mailing Address - Street 1:15 HOSPITAL DR
Mailing Address - Street 2:WESTERN MASS PHYSICIAN ASSOCIATES, INC.
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-6606
Mailing Address - Country:US
Mailing Address - Phone:413-533-3470
Mailing Address - Fax:413-533-6859
Practice Address - Street 1:262 NEW LUDLOW RD
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-4324
Practice Address - Country:US
Practice Address - Phone:413-534-2622
Practice Address - Fax:413-534-2661
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY HEALTH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA176B00000X, 207R00000X, 207V00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T203OtherHARVARD PILGRIM
CT004245983Medicaid
MA9770771Medicaid
MACK1182OtherMEDICARE RAILROAD
M15781OtherBLUECARE 65
M15781OtherBCBS OF MASS
MACK1182OtherMEDICARE RAILROAD
M15781OtherBCBS OF MASS
=========OtherCORVEL
=========OtherHEALTH CARE VALUE MGMT
M15781OtherBLUECARE 65
=========OtherCHILREN'S MED PLAN
=========OtherCONNECTICARE OF MA
MA9770771Medicaid
=========OtherHMC-PPO
T203OtherHARVARD PILGRIM
CT004245983Medicaid
=========OtherCONSOLIDATED HEALTH PLAN
=========OtherCONNECTICARE OF MA
=========OtherFIRST HEALTH