Provider Demographics
NPI:1003607193
Name:BLUE CROSS BLUE SHIELD OF MASSACHUSETTS
Entity type:Organization
Organization Name:BLUE CROSS BLUE SHIELD OF MASSACHUSETTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL POLICY SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:617-470-2541
Mailing Address - Street 1:53 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-1772
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 HUNTINGTON AVE STE 1300
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02199-7611
Practice Address - Country:US
Practice Address - Phone:617-246-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305S00000XManaged Care OrganizationsPoint of Service