CMS-1500 Box 24J / 33a • NPI
1790715910
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
367500000X (CMS 43)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Anesthetist, Certified Registered
Box 32 Service Location & ZIP+4
680 CENTRE ST, ANESTHETICS OF BROCKTON, PC, BROCKTON, MA, 02302-3308
✓ 9-Digit EDI 837 ZIP+4 (02302-3308)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1790715910 (ANESTHETICS OF BROCKTON, PC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1790715910 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | ANESTHETICS OF BROCKTON, PC |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Anesthetist, Certified Registered NUCC Code: 367500000X (Nurse Anesthetist, Certified Registered) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 680 CENTRE ST, ANESTHETICS OF BROCKTON, PC, BROCKTON, MA, 02302-3308 |
| Practice Telephone / Fax | Tel: (508) 941-7000 |
| Administrative Mailing Address | 42 HEMINGWAY DR, RIVERSIDE, RI, 02915-2224 |
| Enumeration & Last Sync | Enumerated: 2006-07-04 | CMS Record Updated: 2025-09-11 |
| Authorized Official | FATHALLA MASHALI (President) |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (367500000X)
What Does Taxonomy Code 367500000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 367500000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Anesthetist, Certified Registered"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (ANESTHETICS OF BROCKTON, PC)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
207L00000X — AnesthesiologyPlain English: Board-Certified Anesthesiologist & Interventional Pain Specialist | State: N/A | License: Verified | Primary: Secondary |
367500000X — Nurse Anesthetist, Certified RegisteredPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Anesthetist, Certified Registered | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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