Codey Gillum, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA5223 Issued in MA

Practice address

125 Parker Hill Ave
Roxbury Crossing, MA 02120-2847

Phone

(617) 754-5000

NPI assigned

Dec 11, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eric J. Woodard MD PCGroup PAC ID 0749253201, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• New England Baptist Hospital Hospital, Boston, MA, CCN 220088

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CGDHAA/Endpoint/CGDHAA
• Direct secure messaging: cgillum254912@direct.bilh.masshiway.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eric J. Woodard, MD PC

  • Neurological Surgery Physician
  • Roxbury Crossing, MA
  • NPI 1023006699
  Medicare reassignment Care Compare group
• Jack City, LLC

  • Durable Medical Equipment & Medical Supplies
  • Watertown, MA
  • NPI 1376002931

  Surgical

  NPD Authorized official
• New England Baptist Medical Associates, Inc.

  • Internal Medicine Physician
  • Roxbury Crossing, MA
  • NPI 1609854991
  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• New England Baptist Hospital

  • General Acute Care Hospital
  • Roxbury Crossing, MA
  • NPI 1699767491
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418256000000",
    "number": "1023416781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 PARKER HILL AVE",
            "city": "ROXBURY CROSSING",
            "state": "MA",
            "postal_code": "021202847",
            "telephone_number": "617-754-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 PARKER HILL AVE",
            "city": "ROXBURY CROSSING",
            "state": "MA",
            "postal_code": "021202847",
            "telephone_number": "617-754-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLUM",
        "first_name": "CODEY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-12-11",
        "last_updated": "2014-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MA",
            "license": "PA5223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren M Flanagan, MSPT
• Frank F Rand MD
• Rosangela Fuentes
• Carol Genereux, NP
• Erin Colleen Gillespie, MSPT
• David Gomolin, M.D.
• Sarah Kristin Grayson, N.P.
• Marilyn P Griffin, M.D.
• Mariana Guandalin
• Christina Jieun Ha, PHARMD

• Surgical Physician Assistant in Roxbury Crossing, MA
• Providers in Roxbury Crossing, MA by specialty
• Surgical Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.