NPIMap

Organization Active NPI

CHMC Otolaryngologic Foundation, Inc

  • Otolaryngology Physician
  • Boston, MA
National Provider Identifier
1124118229
Registry record updated Dec 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
CHMC OTOLARYNGOLOGIC FOUNDATION, INC
Practice address
300 Longwood Ave
Boston, MA 02115-5724
Phone
(617) 355-6460
Fax
(617) 730-0611
NPI assigned
Oct 13, 2006
Last updated
Dec 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2025

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

Authorized official

Name
Kathleen M Hickey
Title
Provider Enrollment Manager
Phone
(617) 355-4956

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X Primary
Pediatric Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YP0228X
AudiologistGroup: 193200000X MULTI-SPECIALTY GROUP 231H00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X
Surgical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AS0400X

Addresses

Primary practice location

300 Longwood Ave
Boston, MA 02115-5724

Mailing address

PO Box 4162
Woburn, MA 01888-4162
Phone (617) 355-6460

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040816000514 MA Part B Supplier - Clinic/Group Practice 9234102526 Receives reassigned benefits from 95 practitioners
Practice locations: Boston, MA

National Provider Directory

National Provider Directory

Locations

300 Longwood Ave
Boston, MA 02115
Phone (617) 355-4956

Practitioners & affiliated clinicians

Practitioners 106

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 106

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765411200000",
    "number": "1124118229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4162",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018884162",
            "telephone_number": "617-355-6460",
            "fax_number": "617-730-0611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LONGWOOD AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155724",
            "telephone_number": "617-355-6460",
            "fax_number": "617-730-0611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHMC OTOLARYNGOLOGIC FOUNDATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2025-12-11",
        "certification_date": "2025-12-11",
        "status": "A",
        "authorized_official_last_name": "HICKEY",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "617-355-4956"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207YP0228X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.