Active NPI
Jacqueline A Gibbes, M.D.
- Pediatrics Physician
- Chelsea, MA
National Provider Identifier
1003997420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 49818
- Practice address
- 1000 Broadway
Chelsea, MA 02150-2247 - Phone
- (617) 660-6600
- Fax
- (617) 887-2794
- NPI assigned
- Oct 19, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 49818 | MA | Primary |
Addresses
Primary practice location
1000 Broadway
Chelsea, MA 02150-2247
Mailing address
1000 Broadway
Chelsea, MA 02150-2247
Phone (617) 660-6600
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3003167 | Medicaid | MA | |
| 99220101 | Other | MA | NETWORK HEALTH |
| E05924 | Other | MA | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49818 | MA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003997420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 BROADWAY",
"city": "CHELSEA",
"state": "MA",
"postal_code": "021502247",
"telephone_number": "617-660-6600",
"fax_number": "617-887-2794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 BROADWAY",
"city": "CHELSEA",
"state": "MA",
"postal_code": "021502247",
"telephone_number": "617-660-6600",
"fax_number": "617-887-2794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBBES",
"first_name": "JACQUELINE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MA",
"license": "49818",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3003167",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NETWORK HEALTH",
"identifier": "99220101",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "E05924",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chelsea, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.