JOHN AUGUSTUS NORTHRIDGE (LICSW) – Clinical Social Worker, NPI 1174586168

JOHN AUGUSTUS NORTHRIDGE (LICSW) is a healthcare provider. based in Weymouth, Massachusetts. specializing in CLINICAL SOCIAL WORKER. They hold the professional credentials LICSW. They hold a License No. 105237 (MA). The NPI Number for JOHN AUGUSTUS NORTHRIDGE (LICSW) is 1174586168

Main info

Male
47 Years Of Experience
Accepts Medicare Assignment
Name
JOHN AUGUSTUS NORTHRIDGE (LICSW)
NPI
1174586168
Phone
(781) 335-6104
Address
11 ORCHARD RD
Enumeration Date
10 April 2006
Last Update Date
8 July 2007

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7812422200
Graduation Year
1979 (47 years ago)
PAC ID
1658326343
Group Practice PAC ID
8729311840
Professional Enrollment ID
I20050315000978
Address ID
MA020622047NO76XXXSTXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:20State licenses:1Digital endpointsOther names

4,194 CLINICAL SOCIAL WORKER in MA

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Provider Addresses for JOHN AUGUSTUS NORTHRIDGE (LICSW)

  • 11, Orchard Road, South Weymouth, Weymouth, Norfolk County, Massachusetts, 02190, United States

    WEYMOUTH, MA 021901636

    Phone: (781) 335-6104

    Type: Mailing

  • 58, Old Colony Avenue, South Boston, Boston, Suffolk County, Massachusetts, 02127, United States

    SOUTH BOSTON, MA 021272406

    Phone: (617) 268-1700

    Fax: (617) 268-1991

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2005-03-15

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20050315000978IClinical Social WorkerMATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 02190)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8729311840View full group profile
NameSpecialtyState
Mental Health CounselorMA
Mental Health CounselorMA
Clinical Social WorkerMA
Clinical Social WorkerMA
Marriage And Family TherapistMI
Mental Health CounselorRI
Mental Health CounselorMA
Mental Health CounselorMA
Mental Health CounselorMA

Reviews

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Frequently asked questions

Where can patients find JOHN AUGUSTUS NORTHRIDGE (LICSW)'s NPI?
You can confirm JOHN AUGUSTUS NORTHRIDGE (LICSW) with NPI 1174586168; it appears in the national provider directory.
Is JOHN AUGUSTUS NORTHRIDGE (LICSW)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
Can you summarize JOHN AUGUSTUS NORTHRIDGE (LICSW)'s specialty in plain language?
Clinically, the directory lists JOHN AUGUSTUS NORTHRIDGE (LICSW) with Clinical Social Worker. Clinical services aligned with this taxonomy classification.
What location shows for JOHN AUGUSTUS NORTHRIDGE (LICSW)?
We surface Weymouth, Massachusetts for JOHN AUGUSTUS NORTHRIDGE (LICSW) based on available NPPES addresses.
Is JOHN AUGUSTUS NORTHRIDGE (LICSW) a real provider?
This page reflects official NPPES data for NPI 1174586168. Always confirm identity and privileges with the practice and licensing boards.

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